Preserving Progress on Nutrition In India: Poshan Abhiyaan in Pandemic Times

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PRESERVING PROGRESS ON NUTRITION IN INDIA:
POSHAN ABHIYAAN IN PANDEMIC TIMES
Designed b y
JULY 21
POSHAN ABHIYAAN
PRESERVING PROGRESS ON
NUTRITION IN INDIA:
IN PANDEMIC TIMES PRESERVING PROGRESS ON
NUTRITION IN INDIA:
POSHAN ABHIYAAN
IN PANDEMIC TIMES AUTHORS: This Report is prepared by a team at WCD Division, NITI Aayog (under
guidance of Dr. Vinod K. Paul, Member (Health), led by Dr. Rakesh Sarwal, Additional
Secretary (Health & Nutrition), Dr. Neena Bhatia (Senior Specialist), Dr. Supreet Kaur
(Senior Consultant), Mr. Kumar Supravin (Senior Consultant), Ms. Prepsa Saini (Consultant)
and Ms Parnika Singh (Intern) along with a team from the International Food Policy
Research Institute (IFPRI) led by Dr. Purnima Menon (Senior Research Fellow), Rasmi
Avula (Research Fellow), Phuong Hong Nguyen (Senior Research Fellow), Monika Walia
(Data Manager), Esha Sarswat (Communications Specialist), Sattvika Ashok (Research
Analyst), Shivani Kachwaha (Research Analyst), Anita Christopher (Research Analyst).
NITI Aayog acknowledges the contributions of the Ministry of Women and Child
Development and Ministry of Health and Family Welfare and all State Governments for
sharing the updated information to prepare the report. Contents
List of Figures v
List of Tables vii
List of Boxes vii
Abbreviations ix
Executive Summary 1
Introduction 1
Methodology 2
Findings 2
Key recommendations 5
1. Introduction 7
1.1 Overview of POSHAN Abhiyaan 7
1.2 Objectives of POSHAN Abhiyaan IV Progress Report 11
2. Methodology 13
2.1 Progress tracking framework 13
2.2 Data collection from states 14
2.3 Data collection from line Ministries 15
2.4 Data collection from development partners 15
2.5 Data analysis 15
2.6 Limitations 20
3. What progress have we made to date? 21
3.1 What progress have States made on delivering POSHAN Abhiyaan? 21
3.2 Conclusion and Way Forward 40
4. Jan Andolan and Multi-Sectoral Interventions 43
4.1 Background 43
iii 4.2 Jan Andolan 43
4.3 Multi-sectoral involvement 48
4.4 Conclusion and Way Forward 54
5. Delivering POSHAN Abhiyaan Interventions during a Pandemic:
How are States doing? 57
5.1 Women and child development services 57
5.2 Maternal and Child Health Services 69
5.3 Multi-sectoral involvement and policy action during COVID-19 88
5.4 Conclusion and Way Forward 92
6. Conclusions and Recommendations 95
7. Key Takeaways from POSHAN Abhiyaan 99
Lesson 1: POSHAN Abhiyaan has helped to bring a strong focus on improving
nutrition outcomes during the first 1,000 days. 99
Lesson 2: POSHAN Abhiyaan has enabled a Nation-wide Jan Andolan
catalysing nutrition related behaviour change at scale for positive
impact on feeding and health care practices 101
Lesson 3: POSHAN Abhiyaan demonstrated that the processes for
Inter-sectoral convergence are effectively operationalized through
in place institutional mechanisms at multiple levels 102
Lesson 4: POSHAN Abhiyaan showed that Technology can be leveraged for
real time monitoring of large scale health and nutrition programmes 103
Lesson 5: POSHAN Abhiyaan supported the resilience of health and
nutrition systems during COVID-19 pandemic 104
Reflection on POSHAN Abhiyaan based on early results available for 22 states
from NFHS-5 105
8. References 107
9. Annexures 109
Annexure 1a: State template-Women and Child Development 109
Annexure 1b: State Template-Health 115
Annexure 2: Rubric 119
Annexure 3: State score dashboard overall 125
Annexure 4: POSHAN Abhiyaan II Monitoring Report: Data Collection Form
for MOWCD 134
Annexure 5: Concordance check between State Template Indicators and
MPR/HMIS Data 164
Annexure 6: Top and bottom performing States/UTs based on Indicators
used in Rubric 165
iv
Contents List of Figures
List of Figures
Figure 1: Overall Implementation Status of POSHAN Abhiyaan at the
National-Level in 2020 3
Figure 2: Pillars of POSHAN Abhiyaan 8
Figure 3: Targets of POSHAN Abhiyaan 9
Figure 4: Critical components for examining the progress to date on rolling
out POSHAN Abhiyaan in the WCD and Health departments 16
Figure 5: Overall implementation status of POSHAN Abhiyaan* at the
national-level in 2020 22
Figure 6: State-wise scores for Government and Institutional Mechanism 23
Figure 7: State-wise comparison of the Percentage Funds utilized up to
FY 2018-19 and FY 2017-18 and up to FY 2019-20 25
Figure 8: Constitution of committees: Comparison between 2019 and 2020 25
Figure 9: Percentage of districts that have developed and submitted CAP
for FY 2019-20 compared to FY 2020-21 at the national level 26
Figure 10: State-wise scores for strategy and planning 27
Figure 11: State-wise scores for Inputs for service delivery and capacity:
Women and Child Development Department 29
Figure 12: Distribution of supplies to districts: Comparison between 2019
and 2020 30
Figure 13: Percentage of CDPOs trained on ICDS Dashboard/Mobile Phones:
Comparison between 2019 and 2020 32
Figure 14: State-wise scores for inputs for service delivery essentials:
Health Department 33
Figure 15: Percentage of functional health facilities: Comparison between
2019 and 2020 35
Figure 16: Percentage of ANM positions filled: Comparison between 2019
and 2020 35
Figure 17: State-wise scores for programme activities and intervention
coverage – Women and Child Development Department 36
Figure 18: State-wise scores for Programme activities and intervention
coverage- Health Department 39
Figure 19: Poshan Maah performance by participation across India, 2020 45
Figure 20: Poshan Maah performance by participation: Comparison between
2019 and 2020 45
Figure 21: Themes covered under POSHAN Maah, 2020 46
v Figure 22: Policy guidance for implementation platforms and interventions
across life stages 58
Figure 23: Changes in supplementary nutrition as per MPR data, October
2019 to December 2020 60
Figure 24: Disruption and restoration of supplementary nutrition among
children 6 months to 6 years of age during the COVID-19
pandemic, MPR data, October 2019 to December 2020 61
Figure 25: Disruption and restoration of supplementary nutrition among
pregnant and lactating women during pandemic, MPR data,
October 2019 to December 2020 62
Figure 26: Policy guidance for interventions during pregnancy, postnatal
and early childhood period 71
Figure 27: Changes in number of pregnant women received full course of
180 IFA tablets, 4 or more ANC check-ups from October 2019 to
December 2020 72
Figure 28: Disruption and restoration of number of pregnant women who
received 180+ IFA tablets, HMIS Data, October 2019-December 2020 73
Figure 29: Disruption and restoration of number of pregnant women who
received four or more ANC visits, HMIS Data, October 2019-
December 2020 75
Figure 30: Changes in the number of institutional deliveries conducted and
the number of women receiving the first post-partum check-up
between 48 hours and 14 days from October 2019 to December 2020 76
Figure 31: Disruption and restoration of number of institutional deliveries
conducted (including C-section), HMIS Data October 2019-
December 2020 77
Figure 32: Disruption and restoration of number of women who received
postpartum check-ups between 48 hours and 14 days, HMIS Data,
October 2019-December 2020 79
Figure 33: Changes in number of children who received fully immunized (9-11
months), 6 HBNC visits (newborns), and health check-up (severely
underweighted children 0-5 years) from October 2019 to December
2020. 80
Figure 34: Disruption and restoration of number of children (9-11 months) fully
immunised, HMIS Data, October 2019-December 2020 81
Figure 35: Disruption and restoration of number of newborns who received
6 HBNC visits after institutional delivery, HMIS Data October
2019-December 2020 83
Figure 36: Disruption and restoration of number of severely underweighted
children (0-5 years) who received health check-ups, HMIS Data,
October 2019- December 2020 84
vi
List of Figures List of Tables
List of Tables
List of Boxes
Table 1: Progress and implementation score themes for WCD and Health
Departments14
Table 2: Categorisation of States 18
Table 3: Service disruption and restoration definition and formulae 19
Table 4: Utilization of funds: Comparison between FY 2017-18 to 2018-19
and FY 2017-18 to FY 2019-20 24
Table 5: Key activities performed during Poshan Maah by Line Ministries 47
Table 6: Summary of ICDS programme delivery innovations in the context
of COVID-19, as reported by State Governments 63
Table 7: Summary of health programme delivery innovations in the context
of COVID-19, as reported by State Governments 85
Box 1: Brief outline of the first three POSHAN Abhiyaan progress reports 10
Box 2: Steps to generate the progress and implementation score 17
Box 3: Improving the micronutrient profile of the ICDS beneficiaries 54
Box 4: Study to assess the THR production and distribution across
12 districts in Jharkhand and Rajasthan 67
Box 5: Frontline health workers enable restoration of health and nutrition service
delivery after early COVID-19 lockdown: Findings from a
seven-state observational study 68
vii Abbreviations
A&T— Alive and Thrive
AMB— Anaemia Mukt Bharat
ANC— Antenatal Care
ANM— Auxiliary Nurse Midwife
ASHA— Accredited Social Health Activist
AWC— Anganwadi Centre
AWW— Anganwadi Worker
AYUSH—
Ayurveda, Yoga and Naturopathy, Unani, Siddha and
Homoeopathy
BRG— Block Resource Group
CAP— Convergence Action Plan
CAS— Common Application Software
CBE— Community-Based Event
CDPO— Child Development Project Officer
CIFF — Children’s Investment Fund Foundation
CHC— Community Health Centre
CMAM— Community-based management of acute malnutrition
CNNS— Comprehensive National Nutrition Survey
CPMU— Central Programme Management Unit
DAY–NRLM—
Deendayal Antyodaya Yojana – National Rural Livelihoods
Mission
DMEO— Development Monitoring and Evaluation Office
DRG— District Resource Group
DWCD — Department of Women and Child Development
DPO — Development Project Officer
DWS— Drinking Water and Sanitation
EIBF— Early Initiation of Breastfeeding
ix FLW— Frontline Workers
FSSAI— Food Safety and Standards Authority of India
H&FW— Health & Family Welfare
HBNC— Home-Based Newborn Care
HBYC— Home-Based Care of Young Child
HMIS— Health Monitoring Information System
HR— Human Resource
HWC— Health and Wellness Centres
ICDS— Integrated Child Development Scheme
IDCF— Intensified Diarrhoea Control Fortnight
IEC— Information, Education and Communication
IFA— Iron and Folic Acid
ILA— Integrated Learning Approach
ISSNIP
—
Integrated Child Development Services (ICDS) Systems
Strengthening and Nutrition Improvement Programme
IYCF— Infant and Young Child Feeding
JAS— Jan Arogya Samiti
JSSK— Janani Shishu Suraksha Karyakram
JSY— Janani Suraksha Yojana
LiST — Lived Saved Tool
LBW— Low Birth Weight
LS — Lady Supervisor
MAM— Moderate Acute Malnutrition
MAS— Mahila Arogya Samitis
MDMS— Mid-Day Meal Scheme
MGNREGS—
Mahatma Gandhi National Rural Employment Guarantee
Scheme
MHRD— Ministry of Human Resource Development
MoHFW— Ministry of Health and Family Welfare
MNREGA—
Mahatma Gandhi National Rural Employment Guarantee
Act
MoE— Ministry of Education
MoPRI— Ministry of Panchayati Raj Institutions
MoRD— Ministry of Rural Development
MPR— Monthly Progress Report
MTC— Malnutrition Treatment Centre
MoWCD— Ministry of Women and Child Development
NCoE-SAM— National Centre of Excellence for Management of SAM
NDD— National Deworming Day
NFHS— National Family Health Survey
NGO— Non-Governmental Organisation
x
Abbreviations NHM— National Health Mission
NRC— Nutritional Rehabilitation Centre
NREGA— National Rural Employment Guarantee Assurance
NRLM— National Rural Livelihood Mission
ODF— Open Defecation Free
ORS— Oral Rehydration Salts
PCV— Pneumococcal Conjugate Vaccine
PDS— Public Distribution System
PMMVY— Pradhan Mantri Matru Vandana Yojana
PMO— Prime Minister’s Office
PRI — Panchayati Raj Institutions
PMSMA— Pradhan Mantri Surakshit Matrutva Abhiyaan
POSHAN—
Prime Minister’s Overarching Scheme for Holistic
Nourishment
RBSK— Rashtriya Bal Swasthya Karyakram
RKSK— Rashtriya Kishori Swasthya Karyakram
RMNCH+A— Reproductive, Maternal, Newborn, Child, and Adolescent
RD— Rural Development
RVV— Rotavirus Vaccine
SAM— Severe Acute Malnutrition
SBCC— Social and Behavioural Change Communication
SBM— Swacch Bharat Mission
SCoE-SAM— State Centre of Excellences for Management of SAM
SHG— Self-Help Group
SNCU— Special Newborn Care Unit
SNP — Supplementary Nutrition Programme
SNRC— State Nutrition Resource Centre
THR— Take-Home Ration
TINI— The India Nutrition India
TPDS— Targeted Public Distribution System
UHSND— Urban Health Sanitation and Nutrition Day
ULB— Urban Local Body
UPHC— Urban Primary Health Care
UT— Union Territory
VHSND— Village Health Sanitation Nutrition Day
WCD— Women and Child Development
WFP— World Food Programme
Abbreviations
xi XXX INTRODUCTION
In 2018, the Government of India launched its flagship programme, the POSHAN (Prime
Minister’s Overarching Scheme for Holistic Nourishment) Abhiyaan, to draw national
attention to and take action against malnutrition, in a mission-mode.
POSHAN Abhiyaan is the Government of India’s flagship programme to improve nutritional
outcomes for children, pregnant women and lactating mothers, and adolescents. The
Abhiyaan is a multi-ministerial convergence mission with the vision to accelerate India’s
progress on malnutrition, in a time bound manner with fixed target. Specifically, the
mission attempts to (1) deliver a high impact package of interventions in the first 1,000
days of a child’s life; (2) strengthen the delivery of these interventions through technology
and management; (3) improve the capacity of frontline workers (FLWs); (4) facilitate
cross-sectoral convergence to address the multi-dimensional nature of malnutrition; and
(5) enhance behaviour change and community mobilization.
Although progress towards improving nutrition outcomes, such as stunting, wasting,
anaemia and low birth weight (LBW), requires a long-term commitment, changes in
critical implementation elements, programme coverage and household behaviours to
accelerate nutritional improvements can be achieved in shorter timeframes.
This fourth progress report on POSHAN Abhiyaan (1) assesses the progress of POSHAN
Abhiyaan implementation (2) analyses the impact of the COVID-19 pandemic on nutrition
and health services; and (3) provides insights on service delivery restorations and
adaptations and other related needs across India. This report presents key recommendations
to deepen India’s efforts to tackle malnutrition, especially in the context of COVID-19.
Lastly, the report highlights five key lessons learned by the implementation of POSHAN
Abhiyaan over the last three years, including following the onset of the coronavirus
pandemic.
Executive
Summary
1 METHODOLOGY
Various data sources were used to generate the findings in this report. NITI Aayog collected
information from State and Union Territories (UTs) using two questionnaires to assess
progress and implementation capabilities on infrastructure, human resources, training
and capacity building, convergence, programme and output activities, service delivery
by FLWs during COVID-19 and the status of innovation and the flexi-plan for March and
July 2020 (Annexure 1). A progress and implementation score framework was developed
to assess the progress and capabilities of State and UTs using the data collected.
NITI Aayog also sought information from key ministries on their initiatives launched under
the auspices of POSHAN Abhiyaan, focusing on interventions during the first 1,000 days.
Furthermore, field-level development partners were encouraged to collect information
on new initiatives, stories of change and models that can be scaled-up and replicated,
and inspiring anecdotes of exceptional individuals working towards improving nutritional
outcomes at the ground-level in the country. NITI Aayog collected this information to
align with the strategic pillars of POSHAN Abhiyaan—namely, convergence, training
and capacity building, Integrated Child Development Services – Common Application
Software (ICDS-CAS) (now POSHAN Tracker Tool), innovations, and behaviour change
and IEC advocacy.
In addition, multiple data sources were used to assess policy guidance, adaptations and
changes in the coverage of key health and nutrition services during the pandemic. State-
level policy guidance from March until October 2020 was examined for 13 States (Andhra
Pradesh, Assam, Bihar, Chhattisgarh, Gujarat, Jharkhand, Karnataka, Madhya Pradesh,
Maharashtra, Odisha, Rajasthan, Uttar Pradesh and West Bengal) using the available
state policy documents in the POSHAN COVID-19 Monitoring report. Data from the state
templates were used to track the service delivery adaptations and innovations made
during the pandemic.
Finally, Health Monitoring Information System (HMIS) data and monthly progress report
(MPR) data from Anganwadi Centres (AWC) from October 2019 to December 2020 were
analysed to examine changes in the coverage of health interventions over the course of
the pandemic.
FINDINGS
This report assesses the implementation of the Mission. A rubric was designed and scores
for states and UTs were tabulated based on their performance in governance, strategy
and planning, availability of inputs, and coverage of key programme activities under
Women and Child Development (WCD) and Health. Figure 1 highlights the performance
of states and UTs based on these scores.
2
Executive Summary 0
10
20
30
40
50
60
70
80
90
100
Maharashtra
Andhra Pradesh
Gujarat
Tamil Nadu
Madhya Pradesh
Himachal Pradesh
Telangana
Karnataka
Odisha
Jharkhand
Chattisgarh
Haryana
Uttarakhand
Rajasthan
Uttar Pradesh
Kerala
Assam
Bihar
Punjab
Sikkim
Meghalaya
Tripura
Goa
Nagaland
Mizoram
Arunachal Pradesh
Manipur
D & N Haveli & Daman…
Chandigarh
Andaman & Nicobar
Jammu & Kashmir
Lakshadweep
Delhi
Puducherry
Ladakh
Score
WCDHealth
Large States Small States UTs
Figure 1: Overall Implementation Status of POSHAN Abhiyaan at the National-Level in 2020
Maximum Score: 100
First, on a positive note, system readiness and capabilities to deliver POSHAN Abhiyaan
interventions improved from previous POSHAN Abhiyaan progress reports. The coverage
of service delivery is also acceptable for many WCD and health activities. Efforts to
prioritize systems preparedness and expand the coverage of key interventions between
2018 and 2020 have likely contributed to the achievements observed during this period.
Second, there is mixed progress across multiple indicators on delivering POSHAN
Abhiyaan between States. Overall, fund utilization is low, with less than half of funds
utilised in 23 States and UTs. Notably, fund utilization is lower in States and UTs with a
low distribution of mobile phones and growth monitoring devices. There are also gaps in
the occupation of HR positions. The constitution of district- and block-level convergence
action plan committees is not uniform across States and UTs, which has implications for
preparing convergence action plans—the roadmap for achieving convergence.
State scores varied across service delivery indicators, including HR, infrastructure,
supplies, training, and capacity building. To continue progress under POSHAN Abhiyaan,
gaps in HR positions must be closed, particularly in States where less than half of the
required positions are filled. There is also a need to close supply gaps in some States. In
addition, several States are underperforming in staff training on e-ILA modules; therefore,
identifying and tackling the determinants for these gaps in training is crucial.
In terms of WCD programme coverage, many States and UTs have distributed take-home
rations (THR) to all beneficiaries. However, coverage remains low in Bihar (65% pregnant
women, 62% lactating women, and 52% children), Punjab (78% pregnant women, 76%
lactating women, and 65% children), Sikkim (84% pregnant women, 84% lactating women,
and 77% children),and Jammu and Kashmir (49% pregnant women, 51% lactating women,
and 54% children). In addition, the percentage of under-five children weighed at AWCs
is still low in many States and UTs.
Executive Summary
3 There are also prevailing gaps in programme activities conducted by health departments.
While the coverage of indicators like early initiation of breastfeeding (EIBF), 180 days
of iron and folic acid (IFA) received by pregnant women and tetanus toxoid (TT2)/
boosters received by pregnant women is acceptable in most States and UTs, the
coverage is relatively low for pregnant women who received albendazole tablets after
the first trimester, lactating women who received IFA, and children who received iron
and folic acid (IFA) syrup. Thus, service delivery across anaemia interventions must
be strengthened. Additionally, States like Bihar, Jharkhand, Kerala, Punjab, Rajasthan,
Telangana, Uttarakhand, North-eastern States and UTs must focus on child immunisation,
antenatal care (ANC) check-ups, and the use of oral rehydration solution (ORS) for
treating diarrhoea.
Overall, there is scope to improve the coverage of interventions during the first 1,000
days. In particular, low coverage of THR, growth monitoring, and IFA supplements across
the life stages need special attention. To this end, challenges on the supply- and demand-
side should be assessed to improve intervention coverage during this critical window of
opportunity.
This report analyses the impacts of the COVID-19 pandemic on the delivery of key essential
services and the actions taken by various line Ministries, State Health Departments and
State WCD Departments to deliver the services despite the pandemic.
Third, the analysis of service disruptions, drawing primarily from publicly available
administrative data, highlights substantial disruptions in the immediate months following
the onset of the pandemic. Encouragingly, by mid-2020, many services had been
restored, and by December 2020, a similar level of service delivery had been achieved
as in December 2019.
Fourth, the findings on early restorations and adaptations to service delivery are promising
and highlight a commitment across policy, implementation and frontline toward restoring
essential services in health, nutrition and social safety nets. Various adaptations to service
delivery were observed across platforms and interventions, which have contributed to
recovery in service provision.
Although there are encouraging signs of recovery, the pandemic has already set in
motion negative impacts on the education of adolescent girls. Evidence shows that
education is critical to prevent early marriage, which, in turn, contributes to preventing
early childbearing in India. The potential risks of early marriage in the context of the
pandemic are higher, but little is known about the extent of the challenge.
This report highlights five key lessons learned from the implementation of the POSHAN
Abhiyaan over the past three years, including amid the COVID-19 pandemic. First, POSHAN
Abhiyaan has prioritised improving nutrition outcomes during the first 1,000 days and has
expanded the focus of nutrition programmes from merely distributing food supplements
to actively engaging supply- and demand-side stakeholders. Second, POSHAN Abhiyaan
created a nationwide Jan Andolan to influence behaviour change, and has galvanized
active participation of all stakeholders. Third, POSHAN Abhiyaan has demonstrated that
intersectoral convergence is possible through in-place institutional mechanisms, and has
4
Executive Summary provided various health and nutrition services across the same beneficiaries. Fourth, the
Abhiyaan has demonstrated that technology can be leveraged for real-time monitoring
of large-scale health and nutrition programmes. Fifth, the Abhiyaan has highlighted the
resilience of health and nutrition systems during the COVID-19 pandemic.
KEY RECOMMENDATIONS
ÂExpand coverage and improve quality of essential health and nutrition
interventions by continuing to strengthen the ICDS and health platforms
Strengthen governance and institutional mechanisms that trigger effective
implementation processes. Assess and close gaps in fund utilization and
expedite the constitution of committees and groups to ensure preparation
and execution of effective Convergence Action Plans (CAPs).
Operationalize the CAPs so that the convergence is outcome-oriented and
interventions across sectors reach the target beneficiaries. For this, it is
important to train the field staff on sharing information and data among
themselves.
To close the gaps on procurement of smartphones, the Anganwadi Workers
(AWWs) can be incentivized for data entry on online application or providing
monthly allowance for rental/usage for using their own devices, as an
alternative.
Close gaps in HR, infrastructure, supplies, and staff training to strengthen
service delivery across ICDS and health programmes. Among the ICDS
services, the priority areas for capacity building includes strengthening of
growth monitoring and home-based counselling.
To address the gaps on coverage of programme activities, Panchayati Raj
Institutions (PRIs) should be involved in community engagement, Village
Health Sanitation Nutrition Day (VHSNDs) in rural areas and Urban Health
Sanitation Nutrition Day (UHSNDs), Urban Local Bodies (ULBs), Mahila
Arogya Samiti (MAS), and Urban Primary Health Care (UPHCs) in urban areas
should be involved in explaining programmatic benefits. Additionally, it is
recommended that a separate interface within POSHAN Tracker application
should be formed which would enable two-way communication system to
address the gaps and challenges at the implementation level.
Identify reasons for low coverage of certain health and nutrition services,
including assessment of supply- and demand-side factors.
ÂServices that will need particular attention in the restoration of services will
be screening and monitoring of growth of all children, active support towards
early initiation of breastfeeding (EIBF) and even greater efforts to support
complementary feeding.
ÂConvergence-related efforts will need maximum effort in the coming years –
targeting and focusing all efforts to be sharply goal-focused – we must achieve
Executive Summary
5 the stated goal of household convergence of key programmes, especially those
addressing the determinants that have seen slow movement or have been
affected sharply in 2020.
ÂEfforts to increase household demand for services are also going to be central
to achieving coverage; therefore, demand creation to access and use of health
and ICDS services should be a key focus of the social and behavioural change
component (SBCC) pillar of POSHAN Abhiyaan in 2021.
ÂThe efforts for convergence with key sectors, especially food and civil supplies
via the public distribution system (PDS) and rural development via the National
Rural Employment Guarantee Act (NREGA) will be essential for strengthening
social protection to vulnerable families. This will also ensure that the social
protection programmes reach families in the first 1,000 days. Furthermore, by
incorporating nutri-cereals, fortified rice, and other nutritious foods into social
safety nets will help to make these provisions nutrition-sensitive.
ÂState- and District-focused diagnostic work, with the support of development
partners and academic institutions, are required to understand the nature of
the determinants of poor nutrition and to diagnose and close gaps in systems
implementation challenges. One size will not fit all States or even all Districts
within a State, but the data will help diagnose areas for improvement and
prioritise targeted actions.
ÂEvidence has accumulated that education is critical to prevent early marriage,
which in turn is critical to prevent early childbearing in India. The risks of
increasing early marriage in the context of the pandemic are higher, but little
is known about the extent of the challenge. Community engagement to ensure
adolescent girls can return to school and that early marriages are prevented
will, therefore, also need sharp focus in 2021. Additionally, RKSK may mobilize
community to prevent early marriage of adolescent girls with the help of FLWs.
In closing, this report and the analysis therein demonstrate that POSHAN Abhiyaan’s
efforts have settled into the political and programmatic fabric of India. Continued emphasis
is needed to deepen the commitment, be strategic and geographically focused in
strengthening the systems to deliver essential nutrition interventions and to strengthen the
available programmes to induce changes in key social determinants of malnutrition. The
progress on improving programme coverage, breastfeeding and complementary feeding
and key determinants of malnutrition such as sanitation coverage shows that results are
attainable. This report provides directions for every State to embrace the mission fully,
address their specific systems and population-level challenges, and contribute to helping
India achieve national and global targets for malnutrition.
6
Executive Summary Introduction1
1.1 OVERVIEW OF POSHAN ABHIYAAN
Launched by the Prime Minister on International Women’s Day on March 8, 2018 in
Jhunjhunu, Rajasthan, POSHAN (the Prime Minister’s Overarching Scheme for Holistic
Nutrition) Abhiyaan aims to prioritize addressing malnutrition in India. Malnutrition can
have life-long, irreversible impacts, currently affecting one in every three children and
half of all women in India.
1
POSHAN Abhiyaan (previously called the National Nutrition Mission) is the Government
of India’s flagship programme to improve nutritional outcomes for children, pregnant
women and lactating mothers. It is a multi-ministerial convergence mission, which aims
to eliminate malnutrition in India by 2022.
Recognizing that malnutrition levels in India are high, POSHAN Abhiyaan attempts to
deliver the following features to fight against malnutrition:
1. A high impact package of interventions, focusing on (but not limited to) the first
1,000 days of a child’s life
2. Strengthening the delivery of a high impact package of interventions through:
ÂRemodelling nutrition monitoring by leveraging technology and management
through the Integrated Child Development Services Common Application
Software (ICDS-CAS) (now POSHAN Tracker Tool);
ÂImproving capacities of frontline workers through the incremental learning
approach (ILA) mechanism;
ÂEmphasising convergent actions among the frontline workforce.
3. A focus on cross-sectoral convergence to emphasise the multi-dimensional nature
of malnutrition, mapping of various schemes contributing towards addressing
malnutrition.
1 Global Nutrition Report, 2018
7
ÂConvergence committees at the state, district and block levels will support
decentralized and convergent planning and implementation, supported by flexi-
pool and innovation funds to encourage contextualised solutions.
4. Ramping up behaviour change communication and community mobilisation through
Jan Andolan, a national nutrition behaviour change campaign that uses community-
based events, mass media and other approaches.
The Abhiyaan focuses on strengthening policy implementation (at the Central- and
State-levels) to improve targeting (identification of high burden Districts), enhance
multi-sectoral convergence, develop innovative service delivery models and rejuvenate
counselling and community-based monitoring. In addition, the mission acknowledges the
need for robust convergence mechanisms and coordination to help multiple government
schemes and programmes reach women and children during the first 1,000 days of life.
The programme also aims to ensure service delivery of key interventions supported by the
use of technology and behavioural change. Figure 2 depicts the key pillars of POSHAN
Abhiyaan that have been proposed to facilitate the objective of the mission.
Figure 2: Pillars of POSHAN Abhiyaan
POSHAN Abhiyaan was first rolled out in 315 priority (high burden) Districts as part of
Phase I (2017-18), 267 Districts as part of Phase II (2018-19), and in the remaining 136
Districts as part of Phase III (2019-20). The Abhiyaan has specific targets to be achieved
across different parameters over the next few years (Figure 3).
POSHAN Abhiyaan is a scheme under ICDS umbrella which converge with other programs
and service delivering nutrition interventions during the first 1000-days period. These
include take-home rations (THR) from Anganwadi Centres (AWC); anaemia prevention
and control under the Anaemia Mukt Bharat (AMB) programme; antenatal care (ANC)
services; dietary counselling on the Village Health Sanitation and Nutrition Day (VHSND);
and schemes such as Pradhan Mantri Surakshit Matrutva Abhiyaan (PMSMA) and
Pradhan Mantri Matrtya Vandana Yojana (PMMVY) that provide quality antenatal check-
ups. Schemes like Janani Suraksha Yojana (JSY) are promoting institutional deliveries
through cash transfers, and free services for delivery and early neonatal care are available
through the Janani Shishu Suraksha Karyakram (JSSK) scheme, which supports mothers
in establishing appropriate breastfeeding and nutrition practices.
8
Introduction -
?Target: ↓ by 6 percentage points
@ 2 percentage points per annum
Prevent and reduce underweight in
children (06 years)
?Target: ↓ by 6 percentage points
@ 2 percentage points per annum
Prevent and reduce stunting in
children (0-6 years)
?Target: ↓ by 9 percentage points
@ 3 percentage points per annum
Reduce the prevalence of anaemia
among children (6-59 months)
?Target: ↓ by 9 percentage points
@ 3 percentage points per annum
Reduce the prevalence of anaemia
among women and adolescent girls
15-49 years
?Target: ↓ by 6 percentage points
@ 2 percentage points per annum
Reduce low birth weight (LBW)
Figure 3: Targets of POSHAN Abhiyaan
Baseline–NFHS 4 (2015-16)
POSHAN Abhiyaan aims to ensure that every child under 6 years of age, every pregnant
and lactating woman, and adolescent girl has access to quality services to address
malnutrition across the continuum of care. This requires a cost-effective, integrated and
sustainable approach that successfully prevents malnutrition and provides care to those
who are malnourished. To achieve this, it is important to strengthen the pillars of the
Abhiyaan in a targeted manner.
Considering the importance of pillars of POSHAN Abhiyaan, the bi-annual POSHAN
Abhiyaan progress reports have been designed to capture the mission’s progress on
convergence, training and capacity building, ICDS-CAS, innovations and implementation
of programme activities conducted by the Women and Child Development (WCD)
and Health Departments. The first POSHAN Abhiyaan Progress Report evaluated the
preparedness of the States/UTs with regards to the mission, the second report evaluated
the implementation of the pillars, whereas the third report provided the status of field-
level roll-out. Building upon the first three reports, this fourth report assesses the
implementation of the key inputs and services. Box 1 outlines the objective and content
of the previous reports.
Introduction
9 BOX 1: BRIEF OUTLINE OF THE FIRST THREE POSHAN
ABHIYAAN PROGRESS REPORTS
i. POSHAN Abhiyaan’s First Progress Report, submitted in December 2018,
evaluated the preparedness of States and UTs for POSHAN Abhiyaan. The
report focused on understanding which systems were in place for the work to
be carried out from March 2018.
Data were obtained from WCD Departments for all States and UTs (except for
West Bengal and Odisha). A preparedness score was assigned to each State
and UT considering the information and data shared. The entire dataset was
organized into three categories:
ÂGovernance and institutional mechanism
ÂStrategy and planning
ÂService delivery essentials
The State-level preparedness scores helped States identify gaps and inform where
to direct their resources to improve the parameters where they were lagging to
combat malnutrition. This detailed analysis, presented in the first progress report
of POSHAN Abhiyaan, helped States and UTs establish an overarching view and
examine the factors leading onto the effective implementation of the Abhiyaan.
ii. POSHAN Abhiyaan’s Second Progress Report, submitted in September 2019,
focused on implementation of parameters covering WCD schemes and Health
interventions at the State- and UT-levels (except West Bengal and Odisha) and
therefore, inputs/data have been considered from both State WCD and Health
Departments. The entire dataset was organized into four categories:
ÂGovernance and institutional mechanism
ÂStrategy and planning
ÂService delivery and capacities
ÂProgramme activities and intervention coverage
iii. POSHAN Abhiyaan’s Third Progress Report, submitted in July 2020, took stock
of the roll-out status in the field and implementation challenges encountered at
various levels using secondary data from the National Family and Health Survey
(NHFS-4) and Comprehensive National Nutrition Survey (CNNS). A modelling
analysis was conducted using the Lived Saved Tool (LiST) to predict the
trends in decline of stunting, wasting and anaemia, and assess how POSHAN
Abhiyaan can scale up coverage of key interventions to accelerate the decline
in malnutrition.
10
Introduction 1.2 OBJECTIVES OF POSHAN ABHIYAAN IV PROGRESS REPORT
This report outlines India’s progress on the POSHAN Abhiyaan, focusing on preserving
nutrition progress during the COVID-19 pandemic. The objectives of this report include:
1. Examine the progress to date on rolling out all POSHAN Abhiyaan interventions
using relevant data;
2. Discuss the importance of preserving progress on the nutrition agenda in the
context of the COVID-19 pandemic; and
3. Recommend key actions to accelerate progress towards India’s nutrition goals.
Introduction
11 2 Methodology
This chapter elaborates on the information collected and the methodology for analysing
data. We examined the progress of States and UTs on implementing POSHAN Abhiyaan
using multiple data sources, including data from semi-structured questionnaires/templates
collected by the States &UTs (Annexure 1), monitoring information systems from the
health department and the ICDS, and additional information from the Ministries. We
analysed progress between 2019 to 2020 using data from the second progress report
as the reference point for 2019. Administrative data, including monthly progress report
(MPR) data of ICDS and Health Management Information System (HMIS) data of the
Ministry of Health and Family Welfare (MoHFW), were utilized to evaluate changes in
service delivery during the COVID-19 pandemic.
2.1 PROGRESS TRACKING FRAMEWORK
Tracking progress on nutrition helps identify strengths, areas for improvement, and inform
options for how to most effectively achieve targets within a proposed timeframe. Between
2019 and 2020, NITI Aayog and development partners jointly developed a framework of
indicators
2
to track progress on nutrition in India. The framework is based on conceptual
and programmatic frameworks for nutrition, as well as programmatic and biological
temporality on how change occurs for various nutrition outcomes. First, in relation to
monitoring progress on the nutrition mission, the team recommended that an assessment
of progress follows the programmatic theory of change, as well as programme and
biological temporality. Second, the team advised that early progress tracking for the
nutrition mission should initially focus on system preparedness and readiness, and then
assess progress on coverage of interventions. Thereafter, the focus may shift to assessing
changes in determinants and outcomes that are relevant to the programme roll-out.
The team also outlined which kinds of data to use to track progress on different parts
of the monitoring framework, focusing on population-level surveys to track progress on
2 Menon et al. 2020
13 outcomes and determinants, and using both population-based surveys and administrative
data to track progress on intervention coverage.
This report covers the period January to December 2020, which mostly coincides with
the active implementation of mission activities, following a long period of aligning actions
across multiple ministries, development partners, states, districts and communities.
Information on themes covering key elements of the pillars of the mission—namely,
Convergence, Training and capacity building, ICDS-CAS (now POSHAN Tracker Tool),
and programme activities—was collected from the Department of Women and Child
Development (DWCD) and Department of Health of States/UTs. Additionally, information
on Jan Andolan and interventions undertaken by various line ministries was collected to
glean insights on behavioural change and IEC advocacy. To this end, the data collected
for this progress report are aligned with the pillars of POSHAN Abhiyaan.
Information on the data collected for the progress and implementation score framework
and the methodology for computation of the scores has been described in the subsequent
sections.
2.2 DATA COLLECTION FROM STATES
Information on the multiple activities which are being conducted by different stakeholders
across the country under POSHAN Abhiyaan was consolidated using the semi-structured
questionnaires/templates. For this purpose, a multi-pronged strategy for data collection
was adopted where NITI Aayog reached out to several central government Ministries,
States & UTs, and development partners to collect the relevant information.
NITI Aayog prepared two assessment questionnaires that captured information related to
infrastructure, HR, training and capacity building, convergence, programme and output
activities, service delivery by FLWs (during the COVID-19 pandemic), and status of
innovation and flexi-plan for March and July 2020 (Annexure 1).
A progress and implementation score framework was developed to assess the
information received from the States and UTs. Broadly, this score measures State and
UT implementation capabilities and progress on the roll-out of POSHAN Abhiyaan. Table
1 summarises the information that was received from the Women and Child Development
(WCD) and Health Departments of States/UTs under four themes.
Table 1: Progress and implementation score themes for WCD
and Health Departments
ThemeWCD DepartmentHealth Department
Governance and Institutional
Mechanism
!Fund Allocation
!Constitution of
Committees and Resource
Groups
Strategy and Planning
!Developed and submitted
convergence action plan
(CAP)
14
Methodology ThemeWCD DepartmentHealth Department
Inputs for Service Delivery &
Capacities
!HR
!Supplies
!Training and Capacity
Building
Infrastructure
HR
Programme activities and
intervention coverage
!Programme activities-
ICDS
Programme activities
AMB strategy
Each of the four themes in Table 1 comprised a different set of sub-themes for the WCD
and Health Departments. A total of 40 indicators–22 on WCD and 18 on health were
included in the framework. These indicators are proxy indicators that intend to reflect the
progress and implementation status of the States and UTs for each of these categories.
The data collected from the States and UTs also underwent a series of data validation
processes to verify that the data are logically correct. For this, multiple rounds of video
conferencing with States/UTs for resolving issues with the data, followed by feedback of
the States and UTs on the calculated scores and agreement on the same, were carried out.
2.3 DATA COLLECTION FROM LINE MINISTRIES
Central-level information was sought from key Ministries–that is, Ministry of Women and
Child Development (MoWCD), Ministry of Health and Family Welfare (MoHFW), Ministry
of Rural Development (MoRD), Ministry of Human Resource Development (now Ministry
of Education, MoE) and Ministry of Panchayati Raj Institutions (MoPRI)–on their various
initiatives launched under the auspices of POSHAN Abhiyaan, focusing on interventions
during the first 1,000 days of life.
2.4  DATA COLLECTION FROM DEVELOPMENT PARTNERS
Development partners with direct presence in the field were encouraged to collect
information on new initiatives, stories of change, models that can be scaled-up and
replicated and on individuals who are conducting exceptional and inspirational work
at the grassroot-level to improve nutrition outcomes in India. These stories have been
compiled and are featured in this report.
2.5 DATA ANALYSIS
2.5.1 Analysis of data from States on system readiness and service
delivery
Computation of State/UT scores
A score was computed and assigned to States and UTs to assess their progress on the
implementation of POSHAN Abhiyaan.
Methodology
15 The progress score is comprised of two sub-scores: one for the WCD Department and
one for the Health Department, both of which have a maximum possible score of 50.
Overall, the maximum possible progress score was 100.
The questions under each theme and sub-theme were based on previous questionnaires
and were selected to ensure comparability with the prior report. The questions selected
for each theme aim to ascertain the progress of states and UTs on the roll-out of POSHAN
Abhiyaan, as per the administrative guidance from the Centre. These elements were
common across all States and UTs (Figure 4).
Figure 4: Critical components for examining the progress to date on rolling out POSHAN
Abhiyaan in the WCD and Health departments
Weights were assigned to the selected indicators for the progress and implementation
score in consultation with experts. For indicators that assessed the status of implementation
or roll-out, a range of weights were used that assigned full credit for completed work
and partial credit for work in progress. For indicators that were measured as proportions,
credit was assigned according to predetermined ranges. Once the weights were assigned,
scores were computed for each theme. Finally, all the theme scores were summed to
compute the overall progress score. Annexure 2 provides the details of the rubric/scoring
framework. Box 2 elaborates on the process for generating the score.
16
Methodology BOX 2: STEPS TO GENERATE THE PROGRESS AND
IMPLEMENTATION SCORE
STEP 1. Developing an assessment tool for States/UTs: NITI Aayog prepared two
implementation assessment questionnaires (one for Health and one for WCD),
which captured information on infrastructure, HR, training and capacity building,
convergence, program and output activities, service delivery by FLW during the
COVID-19 pandemic and the status of innovation and flexi-plan. These were finalized
with inputs from several technical stakeholders (Annexure 1).
STEP 2. Data collection at the State/UT-level: The implementation assessment
questionnaires were sent to State/UT officials in the WCD and Health Departments
in September 2020. Officials in charge gathered the necessary information to
complete the questionnaires and returned them to NITI Aayog between October
and November 2020. Simultaneously, data entry programs were developed in
CSPro version 6.4. Appropriate skip and logic checks were built into the program
to identify any data quality issues.
STEP 3. Data cleaning and round 1 entry: Upon receiving the completed
questionnaires from States and UTs, three independent researchers carried out a
first round of data entry to identify inconsistencies in the responses. Feedback
sheets for every State/UT were developed and shared back with the States/UTs
for revisions and clarifications in November 2020.
STEP 4. Data correction and round 2 entry: Between November 11 and 25, 2020,
video conferences were held with States/UTs to discuss issues identified in the data.
Based on these discussions, corrections were made and information was revised in
the State/UT templates. These corrections were documented and data entered in
the first round were corrected. After all issues were corrected, the second round of
data entry took place. This double data entry approach was applied to ensure higher
data quality. All discrepancies between the two rounds of data were identified and
corrected.
STEP 5. Data processing and analysis: Stata version 16 was used to compare and
analyse data from both rounds. The clean and validated data were used to create
indicators in the scoring framework and assign weights to the scores. Scores for
relevant indicators were then summed to compute the scores for each theme, which
were further summed to obtain the progress and implementation score for each
State/UT based on the scoring framework/rubric.
STEP 6. Data validation by States: All States/UTs were sent their scores and the
estimates of key indicators used for scoring. Video conferences were held with
States/UTs between January 8 and 19, 2021, during which all States/UTs were able to
provide any updates on their responses to the assessment questionnaire and review
the scores. Only data that were validated by States/UTs were used to compute the
scores.
Methodology
17 STEP 7. Concordance checks with MPR and HMIS data: The data on some of the
program activities conducted by DWCD and Department of Health were comparable
to MPR data of ICDS (MoWCD) and HMIS data (MoHFW). If data from State/UT
templates and MPR/HMIS differed by more than 10%, these States and UTs were
contacted to verify the data in April 2021. All discrepancies were then addressed
and corrected. Annexure 5 shows the concordance between the State template
data and MPR/HMIS data.
STEP 8. Data update & final score calculation: Data were revised based on the
revisions provided by the States/UTs and the final scores were generated.
Categorisation of States
This report categorises States and UTs into large States, small States, and UTs to enable
fair comparisons (Table 2).
Table 2: Categorisation of States
Category
Number of
States/UTs
List of States/UTs
Large States 19
Andhra Pradesh, Assam, Bihar, Chhattisgarh, Gujarat, Haryana,
Himachal Pradesh, Jharkhand, Karnataka, Kerala, Madhya
Pradesh, Maharashtra, Odisha, Punjab, Rajasthan, Tamil Nadu,
Telangana, Uttar Pradesh, Uttarakhand
Small States 8
Arunachal Pradesh, Goa, Manipur, Meghalaya, Mizoram,
Nagaland, Sikkim, Tripura
UTs8
Andaman & Nicobar, Chandigarh, D & N Haveli & Daman & Diu,
Delhi, Jammu & Kashmir, Ladakh, Lakshadweep, Puducherry
* Categorization of States/UTs is consistent with previous reports that followed the State Health Index Report.
Findings from Dadra & Nagar Haveli and Daman & Diu have been presented jointly.
Stata version 16 was used to analyse data across survey rounds. All 40 indicators in
the scoring framework/rubric were measured and assigned weights, as per the defined
criteria. The individual scores on the 40 indicators were summed to compute the scores
for each of the themes. Theme scores were then summed as per the scoring framework/
rubric to obtain State/UT progress scores under the WCD and Health Departments.
A set of common indicators between the Second POSHAN Abhiyaan Monitoring Report
and this report were identified to assess progress between 2019 to 2020 using a
percentage change formula.
2.5.2  Analysis of administrative data to assess impact of COVID-19
ICDS Monthly Progress Report (MPR)
AWWs prepare the MPR data based on their service registers, which include the details
of service delivery. The centre-level data are compiled and aggregated to the sector-,
18
Methodology block-, district- and state-levels and become part of the monitoring information system
for the ICDS programme. We examined the coverage of supplementary nutrition during
the pandemic using MPR data between October 2019 and December 2020.
We used State/UT-wise quarterly data for five quarters i.e., from October-December 2019
to October-December 2020 on two indicators: 1) the number of children from 6 months
to 6 years old who received supplementary nutrition and 2) the number of pregnant and
lactating women who received supplementary nutrition. The number of beneficiaries at
the national-level for each quarter was calculated by adding the number of beneficiaries
for all States and UTs.
Service disruption and restoration using MPR data were defined and calculated using
the approach adopted for HMIS data. Table 3 provides the details on definitions and
formulae used.
Table 3: Service disruption and restoration definition and formulae
IndicatorDefinition and formula
Service disruption
Percentage of beneficiaries receiving service during lockdown i.e.,
between April-June 2020 (T1) compared with the pre-pandemic period
i.e. between October–December 2019 (T0)
Early restoration
Percentage of beneficiaries receiving service between July-September
2020 (T2) compared with the pre-pandemic period i.e., October-
December 2019 (T0)
Restoration
Percentage of beneficiaries receiving service between October-
December 2020 (T3) compared with the pre-pandemic period i.e.,
October-December 2019 (T0)
Health Management Information System
India’s HMIS provides monthly information on the operational status of health services
and platforms at the district-, state-, and national-levels. We examined the coverage of
key health and nutrition services between October 2019 and December 2020 using HMIS
data (Accessed on June 17, 2021 from https://hmis.nhp.gov.in/#!/standardReports).
The following coverage indicators available in the HMIS database that pertained to
POSHAN Abhiyaan interventions during the first 1,000 days were included in the analysis:
1) Number of pregnant women given 180 IFA tablets; 2) Number of pregnant women
received 4 or more ANC check-ups ; 3) Number of institutional deliveries conducted
(including C-Sections); 4) Women receiving 1st post-partum checkup between 48 hours
and 14 days; 5) Number of newborns received 6 home-based newborn care (HBNC)
Methodology
19 visits after institutional delivery; 6) Number of children aged between 9 and 11 months
who received full immunisation; 7) Number of severely underweight children provided
health check-up (0-5 years). The number of beneficiaries for a quarter were calculated
by adding the number of beneficiaries for each month in that quarter. Similarly, the
number of beneficiaries at the national level were computed by adding the number of
beneficiaries for all States and UTs.
2.5.3  Analysis of policy guidelines during COVID-19
State-level policy guidance from March to October 2020 was assessed using the available
State policy documents in the POSHAN COVID-19 Monitoring Report for 13 States (Andhra
Pradesh, Assam, Bihar, Chhattisgarh, Gujarat, Jharkhand, Karnataka, Madhya Pradesh,
Maharashtra, Odisha, Rajasthan, Uttar Pradesh and West Bengal).
2.5.4  Analysis of data from States on innovations during COVID-19
Data on State-level service delivery adaptations and innovations during the COVID-19
pandemic were collected in the State templates shared by NITI Aayog (Annexure 1A and
1B), and analysed.
2.6 LIMITATIONS
One limitation is inconsistent reporting and missing data across various indicators
between States and UTs. For instance, no data were available from West Bengal; thus,
West Bengal was excluded from the analysis. Moreover, as this report presents partial
data received from States and UTs, the overall progress scores for certain States and
UTs appear relatively low, which may not appropriately represent the State- or UT-level
progress on POSHAN Abhiyaan implementation.
In addition, some States and UTs provided information from other publicly available data
sources as opposed to internal monitoring systems. Similarly, some States and UTs used
inconsistent data sources for a similar set of indicators.
POSHAN Abhiyaan and its implementation have been rolled out in phases in the country.
The availability of funds, supplies, ICDS-Common Application Software roll-out, training
and capacity building and other related indicators are dependent on the roll-out of the
Abhiyaan in the States/UTs. However, in preparing this report, this differentiation of the
phased roll-out was not accounted for.
Lastly, although the WCD and Health templates were designed to collect a comprehensive
set of information on various topics, responses to questions that were integral to the
scoring framework/rubric were prioritized during the data collection and validation
process with States/UTs.
20
Methodology 3 What progress
have we made
to date?
This chapter examines progress on delivering POSHAN Abhiyaan and on nutrition in India
more broadly. The POSHAN Abhiyaan Monitoring Framework
2
reinforces the importance
of assessing the progress on programme preparedness and coverage of interventions
after launching the programme. Therefore, in examining progress on POSHAN Abhiyaan,
the team retains a focus on system readiness and aspects of programme coverage as
these were lingering areas of challenge identified in the previous progress report and
since programme coverage has been disrupted due to the COVID-19 pandemic.
3.1 WHAT PROGRESS HAVE STATES MADE ON DELIVERING
POSHAN ABHIYAAN?
To assess the implementation progress in all States and UTs, data were collected using
semi-structured questionnaires (Annexure 1A & 1B) from the State/UT WCD and Health
Departments on four key themes related to the inputs and activities under POSHAN
Abhiyaan for March 2020. These include:
1. Governance and institutional mechanisms
2. Strategy and planning
3. Service delivery and capacities
4. Programme activities and intervention coverage
Chapter 2 described the process of data collection, compilation, and computation of
scores. This chapter presents the progress on system capabilities and some areas of
implementation of POSHAN Abhiyaan. All results present findings separately for the 19
large states, eight small states, and seven UTs.
In terms of overall implementation in States and UTs (Figure 5), Maharashtra, Andhra
Pradesh and Gujarat had the highest achievements, followed by Tamil Nadu, Madhya
Pradesh, and Himachal Pradesh. Twelve out of 19 large States had an implementation
score of over 70%. Among the eight small States, Sikkim was the highest performer in
21 overall implementation (more than 75%), followed by Meghalaya, Tripura and Goa. Dadar
and Nagar Haveli and Daman and Diu, Chandigarh, and Andaman and Nicobar Islands
were ranked the top three UTs, which scored over 70%. Since some States and UTs have
incomplete data, it is difficult to comment on the States and UTs that were the lowest
performers.
Figure 5: Overall implementation status of POSHAN Abhiyaan* at the national-level in 2020
Maximum Score: 100
*Based on calculated scores from State Template Data
3.1.1  Monitoring progress on inputs
Programme inputs related to the ICDS and Health platforms are critical for functioning
of POSHAN Abhiyaan pillars. These include funding, HR, supplies and infrastructure,
which have been categorized under key themes: governance and institutional mechanism,
strategy and planning, and service delivery and capacity.
3.1.1.1 Governance and institutional mechanism
This theme captures two critical components pertaining to governance and institutional
mechanisms, as envisaged under POSHAN Abhiyaan:
1. Fund utilization by States/UTs
2. Constitution of committees and resource groups to develop and follow CAP
Fund utilization is an essential component of POSHAN Abhiyaan, which is an interface to
initiate effective implementation. Another crucial institutional mechanism is a convergent
approach to ensure targeted approach to reduce malnutrition. MoWCD recognized the
need for actions of multiple agencies to address malnutrition, and therefore strong
22
What progress have we made to date? convergence of services on-the-ground was emphasised in the guidelines for POSHAN
Abhiyaan. It is of utmost importance to ensure that different inter-related schemes move
from their silos to a unified and convergent action. For this, convergence committees
were envisaged at the State-, District-, and Block-levels, including State Resource Group
(SRG), District Resource Groups (DRG) and Block Resource Groups (BRG) to develop
and follow CAPs. Hence, information on fund utilization, formation of CAP committees
at the Block- and District-level was collected under this head.
On governance and institutional mechanism, the maximum score given to a State/UT is
12. Encouragingly, the utilization of funds and the constitution of resource groups and
committees improved. As a result, States and UTs have scored high on this theme.
ÂLarge States: Haryana, Himachal Pradesh, Kerala, Maharashtra, and Tamil Nadu
scored the highest (11 out of 12 points), while Assam scored the lowest (1) among
all the States due to low formation of committees. Remaining 11 States scored
10 points.
ÂSmall States: Meghalaya and Nagaland scored the maximum score of 12 point,
while Mizoram and Sikkim scored 11, and Arunachal Pradesh and Tripura scored
9. Complete data for Goa and Manipur were not available.
ÂUnion Territories: Four out of the eight UTs including Lakshadweep, Chandigarh,
Dadra & Nagar Haveli and Daman & Diu and Jammu and Kashmir scored 10 or
more points. Puducherry scored lowest points (7). Complete data for Andaman
and Nicobar Island and Delhi were not available, whereas Ladakh received funds
from the central share of Jammu Kashmir.
Figure 6: State-wise scores for Government and Institutional Mechanism
Maximum score: 12
Based on State Template Data
What progress have we made to date?
23 Insights from National- and State-level key findings on the two subthemes of governance
and institutional mechanisms are as follows:
a. Fund Utilization by States/UTs
All States/UTs have received funds from the Centre except Ladakh, which received a
portion of central funds of Jammu and Kashmir.
National-level key findings:
Around 40% of the total funds released under POSHAN Abhiyaan have been utilized
by States/UTs till 31
st
March, 2020. There has been an increase in both the utilization of
funds and the number of states that had utilized more than 50% of the funds from the
end of FY 2018-19 to the end of FY 2019-20 (Table 4).
Table 4: Utilization of funds: Comparison between FY 2017-18 to 2018-19 and
FY 2017-18 to FY 2019-20
Indicator
FY 2017-18 to FY
2018-19
FY 2017-18 to FY
2019-20
% of funds utilized 17%40%
Number of States that have utilized more
than 50% of the total funds released
312
State-level key findings:
By the end of FY 2019-20, Nagaland (87%), Meghalaya (78%), Sikkim (71%), Mizoram (67%)
and Lakshadweep (65%) were utilizing maximum funds, while Punjab (22%), Puducherry
(22%), Tripura (16%), Arunachal Pradesh (9%) and Odisha (8%) utilized the lowest amount
of funds released. (Annexure 6-A).
Among the large States, fund utilization was highest in Kerala (58%) and lowest in Odisha
(8%). Among small States, fund utilization was highest in Nagaland (87%) and lowest in
Arunachal Pradesh (9%); and among UTs, fund utilization was highest in Lakshadweep
(65%) and lowest in Puducherry (22%) by the end of FY 2019-20.
Comparing FY 2017-18 to FY 2018-19, while the percent fund utilization improved in
most (30 out of 35) States/UTs, the percent of fund utilization declined in 5 States/UTs
(Telangana, Mizoram, Daman and Diu and Dadar and Nagar Haveli, and Puducherry)
(Figure 7).
An evaluation of centrally-sponsored schemes conducted by DMEO, NITI Aayog shows
that fund utilization is high on community-based events and IEC materials, but low for
procurement of devices.
3
3 Development Monitoring and Evaluation Office (DEMO), NITI Aayog, 2020
24
What progress have we made to date? Figure 7: State-wise comparison of the Percentage Funds utilized up to FY 2018-19 and FY
2017-18 and up to FY 2019-20
Note: Ladakh was excluded because Jammu Kashmir gave a proportion of their central funds to Ladakh after
the UT was formed. Due to this, no separate Central Funds were allocated to this Union Territory.
b. Constitution of Committees and Resource Groups
National-level key findings:
By March 2020, DRGs had been formed in 94% of the districts and BRGs had been formed
in 96% of the blocks. Compared with the end of March 2019, there was an increase in
the districts with DRGs by 7 percentage points and Blocks with BRGs by 18 percentage
points (Figure 8). Additionally, the percentage of districts where CAP Committees have
been formed also increased by 7 percentage points from 2019 to 2020.
Figure 8: Constitution of committees: Comparison between 2019 and 2020
Note:
To calculate the national estimate, mean of States/UT available in both rounds was computed (excluded Odisha
and Ladakh from 2020 national estimate to keep States & UTs common).
For estimating cumulative % for D&N & D&D for the year 2019, mean of both UTs has been calculated & used.
What progress have we made to date?
25 State-level key findings
Most States/UTs had constituted DRGs, BRGs and CAP committees. It is to be noted
that DRGs were formed in all districts in all States/UTs except for Delhi, Puducherry,
Assam and Ladakh. Similarly, BRGs were formed in all blocks in all States/UTs except
for Tripura, Meghalaya, Assam and Ladakh. All States/UTs had 100% districts with CAP
committees, except Chhattisgarh, Odisha, Puducherry, Assam and Goa (Annexure 6-A).
Complete information for the constitution of committees was not available for Goa,
Manipur, Andaman and Nicobar Island and Delhi.
The constitution of DRGs, BRGs, and CAP committees has improved at the national-
and state- level. However, there is also a need to ensure that these resource groups
and committees plan interventions in a way that the interventions do reach intended
beneficiaries.
3.1.1.2 Strategy and planning
This theme examined the elements of cross-sectoral convergence and included two
indicators:
1. Whether the State/UT CAP has been submitted to the Central Project
Management Unit (CPMU) for the year 2020-21
2. Proportion of Districts that developed and submitted the CAP for the year
2020-21
National level key findings
CAPs are paramount to map the way forward for multi-sectoral convergence; therefore, it
is noteworthy that around 83% of districts had developed and submitted CAP for 2020-
21. The percentage of districts that had developed and submitted CAP in FY 2020-21
improved by 13 percentage points compared with FY 2019-20 (Figure 9).
Figure 9: Percentage of districts that have developed and submitted CAP for FY 2019-20
compared to FY 2020-21 at the national level
Note:
To calculate the national estimate, mean of States/UT available in both rounds was computed (excluded
Odisha and Ladakh from 2020 national estimate to keep States & UTs common).
For estimating cumulative % for D&N & D&D for the year 2019, mean of both UTs has been calculated &
used.
26
What progress have we made to date? State-level key findings
Although the overall number of States that had developed and submitted CAP has
improved, certain States and UTs have very few districts that have submitted CAP.
Additionally, the field surveys conducted in 13 States/UTs indicates that, although majority
of States/UTs had prepared and submitted CAPs, it is still not clear what actions usually
result from the monitoring and review of the CAPs
3
.
Figure 10: State-wise scores for strategy and planning
Max score: 3
Based on State Template Data
ÂLarge States: 15 out of 19 States had submitted CAP to CPMU FY for 2020-21,
whereas Kerala, Maharashtra, Odisha and Punjab had not submitted CAP yet.
These four States had lower scores because they did not submit CAP.
ÂAdditionally, 13 States had 100% districts that developed and submitted CAP
for FY 2020-21. Uttrakhand and Assam had the least number of districts that
developed and submitted CAP due to which they scored 1.5 out of 3. On a
positive note, 12 States scored maximum possible score.
ÂSmall States: All small States submitted CAP to CPMU for FY 2020-21. Information
was not available for Manipur and Delhi. Additionally, most small states (6 out of
8) had 100% districts that developed and submitted CAP for FY 2020-21. Goa
scored the lowest because none of its districts developed and submitted CAP.
ÂUnion Territories: All UTs except Dadar and Nagar Haveli and Daman and Diu,
and Jammu and Kashmir submitted CAP to CPMU for FY 2020-21. There were 5
UTs where all districts developed and submitted CAP for FY 2020-21, while the
number of districts is very low in Andaman and Nicobar Island and Puducherry.
Annexure 6-B lists the States and UTs where all districts have developed and submitted
CAP for FY 2020-21.
What progress have we made to date?
27 3.1.1.3 Inputs for service delivery & capacity
The categories covered under this theme included human resources, infrastructure,
supplies, training, and capacity building. Annexure 2 provides a detailed list of indicators
that were considered for each of these categories. These inputs are necessary for ensuring
delivery of services with adequate coverage, continuity, intensity and quality (C
2
IQ).
Departments of Women and Child Development
The sub-themes covered human resources, supplies and training and capacity of the staff.
Since human resources are critical for programme implementation, information on the
percentage of filled positions for the posts of Joint Project Coordinator, Consultant and
Project Associate under POSHAN Abhiyaan was collected across States.
In terms of supplies, data on distribution of mobile phones and growth monitoring devices,
including weighing scales for infants and adults and height measuring instruments (e.g.
infantometers and stadiometers), were collected for monitoring the supplies under
DWCD. Supply of mobile phones and growth monitoring devices are an important input
especially for roll-out of ICDS-CAS, and for conducting growth monitoring activities at
the Anganwadi Centres. Therefore, adequate supplies are important both for providing
services and for monitoring the coverage of the services.
Lastly, as capacity building of human resources is an integral step for ensuring high quality
services, this report emphasises assessing the percentage of trained professionals. For
assessing this, the percentage of Lady Supervisors and Anganwadi workers trained on
e-ILA, and child development project officers (CDPOs) and lady supervisors trained on
dashboard/mobile was collected.
As per the score rubric, the maximum score that can be assigned under the service
delivery and capacity theme is 23 points. In six States and UTs, data were not available
for all the indicators under this theme.
ÂLarge States: 16 States had data for all indicators, out of which Gujarat, Tamil
Nadu and Andhra Pradesh scored between 22-23 points, whereas Haryana
scored 7 points. Complete information was not available for Madhya Pradesh,
Odisha and Punjab.
ÂSmall States: Meghalaya and Sikkim scored 19 points, whereas Arunachal Pradesh
scored only 4 points out of the maximum possible score of 23 points. Complete
information was not available for Arunachal Pradesh and Manipur.
ÂUnion Territories: Chandigarh and Dadra & Nagar Haveli and Daman & Diu
scored the maximum score (23), followed by Andaman & Nicobar (22), whereas
Puducherry scored only 7 points. Complete information was not available for
Ladakh.
28
What progress have we made to date? Figure 11: State-wise scores for Inputs for service delivery and capacity: Women
and Child Development Department
Max score: 23
Based on State Template Data
Insights from national- and state-level key findings on the three sub-themes of inputs for
service delivery for WCD are as follows:
a. Human Resources
State-level key findings:
ÂJoint Project Coordinator: 12 large States (Andhra Pradesh, Bihar, Gujarat,
Himachal Pradesh, Jharkhand, Kerala, Madhya Pradesh, Maharashtra, Rajasthan,
Tamil Nadu, Telangana, Uttarakhand), 4 small States (Meghalaya, Mizoram,
Nagaland, Sikkim), and 4 UTs (Chandigarh, Dadar & Nagar Haveli and Daman &
Diu, Delhi, Jammu & Kashmir) had filled 100% positions. While 9 States/UTs had
less than 25% positions filled (Annexure 6-C).
ÂConsultants: 7 large States (Assam, Bihar, Gujarat, Himachal Pradesh, Madhya
Pradesh, Rajasthan, Telangana), one small State (Mizoram), and 3 UTs (Andaman
& Nicobar Island, Chandigarh, Dadar & Nagar Haveli and Daman & Diu) had filled
100% of the positions. While 10 States/UTs had less than 25% positions filled
(Annexure 6-C).
ÂProject Associate: 10 large States (Andhra Pradesh, Bihar, Gujarat, Haryana,
Himachal Pradesh, Kerala, Madhya Pradesh, Rajasthan, Telangana, Uttarakhand),
4 small States (Meghalaya, Mizoram, Nagaland, Sikkim), and 4 UTs (Andaman
& Nicobar Island, Chandigarh, Dadar & Nagar Haveli and Daman & Diu,
Lakshadweep) had filled 100% of the positions. While 9 States/UTs had less
than 25% positions filled (Annexure 6-C).
What progress have we made to date?
29 States/UTs—namely Punjab (0%), Goa (0%), Tripura (0%), Puducherry (0%), Odisha (33%
of Joint Project Coordinator; 0% of Consultants and Project Associates), Uttar Pradesh
(29% of Joint Project Coordinator; 0% of Consultants and Project Associates), Arunachal
Pradesh (60% of Consultants; 0% of Joint Project Coordinator and Project Associates),
and Jammu and Kashmir (100% of Joint Project Coordinator; 0% of Consultants and
Project Associates) had least positions filled due to which they scored lower than other
States. Annexure 6-C lists the States and UTs with the highest and lowest HR positions
filled. Data for Manipur and Ladakh were not available.
b. Supplies
National-level key findings:
Data were analysed on the district-level distribution of supplies nationwide. In March 2020,
71% of mobile phones, 77% of infant weighing scales, 79% of adult weighing scales, 82%
of infantometers and 80% of stadiometers were distributed to the districts. Compared
with 2019, the distribution of supplies had increased significantly (Figure 12).
Figure 12: Distribution of supplies to districts: Comparison between 2019 and 2020
Note:
To calculate the national estimate, mean of States/UTs available in both rounds was computed (excluded
Odisha and Ladakh from 2020 national estimate to keep States & UTs common).
For estimating cumulative % for D&N & D&D for the year 2019, mean of both UTs has been calculated & used.
State-level key findings:
ÂLarge States: 8 States (Andhra Pradesh, Bihar, Gujarat, Haryana, Jharkhand,
Maharashtra, Tamil Nadu and Uttarakhand) had distributed 100% of mobile
phones, and 10 States (Andhra Pradesh, Gujarat, Himachal Pradesh, Karnataka,
Kerala, Maharashtra, Punjab, Tamil Nadu, Telangana and Uttarakhand) had
distributed 100% of growth monitoring devices. Himachal Pradesh, Kerala,
Punjab and Odisha had not distributed any mobile phones. Supplies were lowest
in Odisha (0% supplies) and Uttar Pradesh (31% mobile phones; 38% infant
weighing scales; 39% adult weighing scales; 0% infantometers and stadiometers
were distributed).
30
What progress have we made to date?
ÂSmall States: 4 States (Meghalaya, Mizoram, Nagaland and Tripura) distributed
100% of mobile phones, and 4 States (Goa, Meghalaya, Mizoram and Nagaland)
had distributed 100% of growth monitoring devices. Supplies were lowest in
Arunachal Pradesh (0% mobile phones, infant weighing scale, and adult weighing
scale; 2% infantometers; 2% stadiometers were distributed) and Manipur (21%
mobile phones; and 0% growth monitoring devices).
ÂUnion Territories: 5 UTs (Andaman & Nicobar Island, Chandigarh, Dadar & Nagar
Haveli and Daman & Diu, Delhi and Ladakh) had distributed 100% of mobile
phones, and all UTs had distributed all growth monitoring devices.
Annexure 6-C lists the States/UTs with highest and lowest distribution of supplies to the
districts.
c. Training and Capacity Building
State-level key findings:
ÂTraining on e-ILA: 7 Large States (Andhra Pradesh, Gujarat, Madhya Pradesh,
Odisha, Rajasthan, Tamil Nadu and Uttar Pradesh), 3 Small States (Meghalaya,
Sikkim and Tripura), and 4 UTs (Andaman & Nicobar Island, Chandigarh, Dadar
& Nagar Haveli and Daman & Diu, Jammu & Kashmir) had trained 100% LS, while
5 large States (Gujarat, Madhya Pradesh, Odisha, Tamil Nadu, Uttar Pradesh), 1
small State (Sikkim), and 4 UTs (Andaman & Nicobar Island, Chandigarh, Dadar
& Nagar Haveli and Daman & Diu, Jammu & Kashmir) had trained 100% AWW.
In 15 States/UTs, no LS had completed training. Similarly, in 15 States/UTs, no
AWWs had completed training.
ÂTraining on Dashboard/Mobile phones: 5 Large States (Andhra Pradesh, Bihar,
Gujarat, Kerala, Tamil Nadu), 3 Small States (Nagaland, Sikkim, Tripura), and 5
UTs (Andaman & Nicobar Island, Chandigarh, Dadar & Nagar Haveli and Daman
& Diu, Delhi, Lakshadweep) had trained 100% CDPOs, while 6 large States, 3
small States, and 4 UTs had trained 100% LS. In 9 States/UTs, no CDPOs had
completed training. Similarly, in 8 States/UTs, no LS had completed training.
Complete information on training was not available for Madhya Pradesh, Odisha, Punjab,
Arunachal Pradesh and Manipur.
Only a few States/UTs had trained adequate staff, while there are States/UTs like Assam,
Haryana, and Karnataka where no staff had been trained on e-ILA and Dashboard/mobile
phones (Annexure 6-C). According to interviews held with State Officials under ICDS,
gaps in training continue to exist due to low basic educational background and comfort
levels in using technology among AWWs, especially among older AWWs
3
.
The percentage of CDPOs trained on ICDS Dashboard/Mobile nearly doubled, from 30%
in 2019 to 59% in 2020 (Figure 13). Complete information for Manipur, Madhya Pradesh,
Odisha, Punjab and Arunachal Pradesh was not available.
What progress have we made to date?
31 Figure 13: Percentage of CDPOs trained on ICDS Dashboard/Mobile Phones: Comparison
between 2019 and 2020
Note:
To calculate the national estimate, mean of States/UT available in both rounds was computed (excluded Odisha
and Ladakh from 2020 national estimate to keep States & UTs common).
For estimating cumulative % for D&N & D&D for the year 2019, mean of both UTs has been calculated & used.
As per the Women and Child Development Dashboard (accessed on 27 May 2021),
Ministry of Women and Child Development, as on 11 September 2020, ICDS-CAS had
been rolled out in 29 States with 359 districts of the country. While all districts had been
covered under ICDS-CAS in 16 States and UTs, significant proportions of districts had not
been covered in Chhattisgarh, Jharkhand, Madhya Pradesh, Rajasthan and Uttar Pradesh.
Additionally, nearly half (48%) of Anganwadi Workers had received smartphones and 56%
Lady Supervisors had received smartphones as on September 2020.
4
Although the procurement of smartphones by staff and the distribution of mobile phones
to the districts have improved, a field survey conducted as a part of an evaluation of
centrally-sponsored schemes of

WCD
3
found that the ICDS-CAS had faced numerous
challenges. First, roll out of ICDS-CAS remained slow due to network issues in many
districts. Second, the qualitative survey conducted for 119 AWWs (DEMO) indicates that
most AWWs using mobile/tablets continue to maintain records manually, which led to
duplication of work. The challenges pertaining to ICDS-CAS made it an inefficient model,
leading the ICDS-CAS to be replaced by the POSHAN Tracker, which must be rolled out
completely and duplication of record keeping must be avoided to save time and enhance
the effectiveness of AWWs.
Overall, the scores indicate that several States/UTs need to strengthen the delivery system
for effective service delivery – mostly by improving training and capacity building. To
continue progress on POSHAN Abhiyaan, gaps in human resource positions must be
closed, and most urgently in States where <25% of the required positions are filled. There
is also a need to close the supply gaps in some States. In addition, there are large gaps in
staff training on e-ILA modules across several States. There is an urgent need to identify
the reasons for such gaps in training and address them.
4 Women and Child Development Dashboard, MOWCD, https://wcd.dashboard.nic.in/ (accessed on 27 May
2021)
32
What progress have we made to date? Departments of Health and Family Welfare
To examine health-related service delivery and capacity, infrastructure and HR domains
were assessed. Information was available for all States and UTs except Mizoram.
The percentage of sanctioned health facilities, including functional sub-centres, community
health centres (CHCs), and health and wellness centres (HWCs), were collected from States
and UTs. These health facilities are a one-stop shop for essential child and maternal health
services; thus, it is extremely important for States and UTs to have as many functional
health facilities as sanctioned. In terms of human resources, the percentage of auxiliary
nurse midwife (ANM) positions filled was collected from States and UTs.
As per the rubric, a maximum of 12 points was allotted to service delivery, 3 points for
HR and 9 points for Infrastructure. Most States/UTs scored well on functional sub-centres
and CHCs, but low on functional HWCs.
ÂLarge States: Andhra Pradesh, Gujarat, Karnataka and Kerala scored the highest
possible score of 12 points, and 14 other states scored between 9 and 11 points.
Bihar scored the lowest (6) due to the low number of functional health facilities
and low ANM positions filled. Complete information was not available for Punjab.
ÂSmall States: Goa scored 12 points, while the others scored between 9 and 11
points. Arunachal Pradesh scored low due to the low number of functional health
facilities. Complete information was not available for Mizoram.
ÂUnion Territories: Dadra & Nagar Haveli and Daman and Diu scored the highest
possible score (12), whereas Delhi and Chandigarh scored 9 points. Complete
information was not available for Chandigarh and Delhi.
Figure 14: State-wise scores for inputs for service delivery essentials: Health Department
Maximum score: 12
Based on State Template Data
What progress have we made to date?
33 Insights from National- and State-level key findings on the two subthemes of inputs for
service delivery for Health are as follows:
a. Infrastructure
State-level key findings:
ÂLarge States: 13 States (Andhra Pradesh, Assam, Chhattisgarh, Haryana, Himachal
Pradesh, Karnataka, Kerala, Madhya Pradesh, Odisha, Tamil Nadu, Telangana,
Uttar Pradesh and Uttarakhand) had 100% functional sub-centres, 14 States
(Andhra Pradesh, Chhattisgarh, Haryana, Himachal Pradesh, Karnataka, Kerala,
Madhya Pradesh, Maharashtra, Odisha, Rajasthan, Tamil Nadu, Telangana, Uttar
Pradesh, Uttarakhand) had 100% functional CHCs, and 3 States (Andhra Pradesh,
Kerala and Punjab) had 100% functional HWCs. Bihar had the lowest number of
functional health facilities (60% of sub-centres, 43% of CHCs and 30% of HWCs).
ÂSmall States: 2 States (Goa and Sikkim) had 100% functional sub-centres, 4
States (Goa, Manipur, Meghalaya and Sikkim) had 100% functional CHCs, and
2 States (Goa and Nagaland) had 100% functional HWCs. The results indicate
that Arunachal Pradesh (63% of sub-centres and 39% of HWCs) and Nagaland
(76% of sub-centres and 64% of CHCs were functional) should focus more on
infrastructure. Information regarding the health infrastructure was not available
for Mizoram.
ÂUnion Territories: 6 UTs (Andaman & Nicobar Island, Dadar & Nagar Haveli
and Daman & Diu, Delhi, Jammu & Kashmir, Ladakh, Puducherry) had 100%
functional sub-centres, 8 UTs (Andaman & Nicobar Island, Chandigarh Dadar &
Nagar Haveli and Daman & Diu, Delhi, Jammu & Kashmir, Ladakh, Lakshadweep,
Puducherry) had 100% functional CHCs and 3 UTs (Chandigarh, Dadar & Nagar
Haveli and Daman & Diu, Lakshadweep) had 100% functional HWCs. Complete
information on health infrastructure was not available for Chandigarh and Delhi.
In total, most States had more than 75% functional sub-centres and CHCs, while number
of functional HWCs are lower compared to other health facilities. Annexure 6-D lists the
States/UTs with the highest and lowest number of functional health facilities.
Additionally, the percentage of functional sub-centres increased slightly, from 92% in
2019 to 94% in 2020. However, the percentage of functional CHCs decreased marginally,
from 97% in 2019 to 95% in 2020 (Figure 15). The number of sanctioned CHCs have
increased for many States and UTs in 2020, which contributed to an overall reduction in
the percentage of functional CHCs in 2020 compared with the previous year.
34
What progress have we made to date? Figure 15: Percentage of functional health facilities: Comparison between 2019 and 2020
Note:
To calculate the national estimate, mean of States/UT available in both rounds was computed (excluded
Odisha and Ladakh from 2020 national estimate to keep States & UTs common).
For estimating cumulative % for D&N & D&D for the year 2019, the mean of both UTs has been calculated
and used.
b. Human Resources
National level key finding:
According to the State-level data collected, 87% of ANM positions were filled in 2020,
which is slightly higher than 85% in 2019 (Figure 16).
Figure 16: Percentage of ANM positions filled: Comparison between 2019 and 2020
Note:
To calculate the national estimate, mean of States/UT available in both rounds was computed (excluded
Odisha and Ladakh from 2020 national estimate to keep States & UTs common).
For estimating cumulative % for D&N & D&D for the year 2019, mean of both UTs has been calculated &
used.
State-level key findings:
ÂLarge States: 15 States have filled more than 75% of the ANM positions, whereas
the data for Punjab were not available. Odisha filled 100% of its ANM positions,
Bihar (52%), Uttar Pradesh (61%), and Himachal Pradesh (71%) had filled less than
75% of ANM positions. Information on ANM positions filled was not available
for Punjab.
ÂSmall States: 6 States (Arunachal Pradesh, Goa, Manipur, Meghalaya, Nagaland
and Sikkim) have filled more than 75% of the ANM positions, whereas the data
for Mizoram were not available. Tripura (56%) had filled less than 75% of ANM
positions. Information on ANM positions filled was not available for Mizoram.
ÂUnion Territories: All UTs have filled more than 75% of the ANM positions.
What progress have we made to date?
35 States like Himachal Pradesh, Uttar Pradesh, Tripura and Bihar had the least ANM
positions filled (Annexure 6-D). Therefore, there is an urgent need to close the gap in
ANM vacancies in these States, as they are a critical work force for delivering a range of
maternal health interventions.
3.1.2 Monitoring progress on programme activities and
intervention coverage
To assess the progress of States and UTs on programme activities and intervention
coverage, data from the WCD Departments on select ICDS activities as well as data from
the Health Departments on a set of interventions were analysed. Annexure 2 provides a
detailed list of indicators that were considered for calculating the scores.
Departments of Women and Child Development
Activities such as Take-Home Ration and weighing of children aged 0-5 years were
selected for assessing the progress of ICDS activities. The data was collected from the
States and UTs through the State Template shared with them. Data received for the
month of March 2020 in state-filled information was checked for concordance with the
MPR data from MoWCD. Annexure 5 presents the concordance check findings.
As per the rubric, a maximum of 12 points were allotted to programme activities and
intervention coverage of WCD.
ÂLarge States: 15 States had complete information, among which 8 States had
the maximum possible score of 12, while Bihar had the lowest score (6 points).
Complete information was not available for Assam, Rajasthan, Uttar Pradesh
and Uttarakhand.
ÂSmall States: Out of 5 small States for which complete information was available,
Goa, Sikkim and Tripura scored the highest (12 points). Complete information
was not available for Arunachal Pradesh, Manipur and Nagaland.
ÂUnion Territories: Among the UTs, 5 UTs scored 12, whereas Jammu and Kashmir
scored only 7.
Figure 17: State-wise scores for programme activities and intervention coverage –
Women and Child Development Department
Maximum Score: 12 Based on State Template Data
36
What progress have we made to date? State-level key findings:
ÂLarge States: 7 States (Gujarat, Jharkhand, Kerala, Maharashtra, Odisha, Rajasthan,
Tamil Nadu) had distributed THR to 100% pregnant women registered at AWC, 5
States (Jharkhand, Kerala, Maharashtra, Odisha and Tamil Nadu) had distributed
THR to 100% of lactating women registered at AWCs, and 6 States (Jharkhand,
Kerala, Maharashtra, Odisha, Tamil Nadu and Uttar Pradesh) had distributed
THR to 100% of children 6-36 months of age registered at AWCs. Large States
with the lowest THR coverage included Bihar (65% of pregnant women, 62% of
lactating women and 52% 0f children), Haryana (63% of pregnant women, 63%
of lactating women, and 59% of children) and Punjab (78% of pregnant women,
76% of lactating women, and 65% of children).
Additionally, in 10 States (Andhra Pradesh, Chhattisgarh, Gujarat, Haryana,
Karnataka, Madhya Pradesh, Maharashtra, Odisha, Punjab and Tamil Nadu) more
than 75% of children 0-5 years of age who were weighed, while Bihar and Kerala
had less than 20% children who were weighed. (Annexure 6-E)
ÂSmall States: 3 States (Meghalaya, Mizoram and Tripura) had distributed THR
to 100% of pregnant women registered at AWCs, 4 States (Goa, Meghalaya,
Mizoram and Tripura) had distributed THR to 100% of lactating women registered
at AWCs, and 3 States (Meghalaya, Mizoram and Tripura) had distributed THR
to 100% of children 6-36 months of age registered at AWCs. While Sikkim
(84% pregnant women, 84% lactating women and 77% children) had the lowest
coverage of THR. Additionally, 3 States (Goa, Sikkim and Tripura) had more than
75% of children aged 0-5 who were weighed, whereas Arunachal Pradesh had
less than 25% children who were weighed.
ÂUTs: 6 UTs (Andaman & Nicobar Island, Dadar & Nagar Haveli and Daman & Diu,
Delhi, Ladakh, Lakshadweep and Puducherry) had distributed THR to 100% of
pregnant women registered at AWCs, 5 UTs (Andaman & Nicobar Island, Delhi,
Ladakh, Lakshadweep and Puducherry) had distributed THR to 100% of lactating
women registered at AWCs, and 5 UTs (Andaman & Nicobar Island, Dadar &
Nagar Haveli and Daman & Diu, Delhi, Ladakh, Lakshadweep) had distributed
THR to 100% children 6-36 months of age registered at AWCs. Among UTs,
the lowest THR coverage was in Jammu and Kashmir (49% pregnant women,
51% lactating women, and 54% children). Additionally, 5 UTs (Andaman and
Nicobar Island, Chandigarh, Dadar and Nagar Haveli and Daman and Diu, Delhi,
Lakshadweep) had more than 75% of children aged 0-5 who were weighed,
while Ladakh had less than 25% children who were weighed.
It is imperative to examine the reasons for low coverage of THR and growth monitoring.
States and UTs should assess whether the gaps in THR coverage pertain to supply chain
issues or are a result of demand-side challenges. For growth monitoring, States should
review if there are gaps in staff training on measuring children, availability of supplies or
in community awareness to avail the service, and identify appropriate solutions.
What progress have we made to date?
37 Departments of Health and Family Welfare
Using data on immediate determinants, coverage of ANC, postnatal care, and early
childhood interventions, and supplies from the State Health Departments, 14 indicators
were constructed to assess State/UTs progress on intervention delivery. Among
Programme Activities and Intervention coverage, indicators were divided into following
sub-themes:
1. Programme Activities
2. Anaemia Mukt Bharat Strategy
The data was collected from the States and UTs through the State Template shared with
them. Data received for the month of March 2020 in state-filled information was checked
for concordance with the HMIS data from MoHFW was done on indicators that were
comparable. Annexure 5 presents the findings from the concordance check.
Based on the progress on programme activities and implementation of the AMB strategy,
States and UTs were ranked on a scale of 38 points. The overall scores are low due
to indicators like children receiving 8-10 doses of IFA syrup, IFA received by lactating
women, pregnant women who received Albendazole tablet after first trimester, and
procurement of haemoglobin meter. Scores were also low for children receiving weekly
IFA and conducting home visits for pregnant women amid COVID-19 in March 2020.
ÂLarge States: Information was available on all the indicators for 10 States only,
among which Maharashtra and Himachal scored the highest (32 points), whereas
the remaining 8 States scored between 25 and 31 points. Complete information
was not available for Bihar, Gujarat, Himachal Pradesh, Karnataka, Kerala, Odisha,
Punjab, Rajasthan and Uttar Pradesh.
ÂSmall States: Of the 8 small States, 7 were missing information on at least one
indicator. Sikkim was the only small state with complete information and scored
the highest (26 points). Mizoram provided no information on health programme
activities.
ÂUnion Territories: Of 8 UTs, Chandigarh, Delhi and Lakshadweep did not have
information on at least one indicator. Dadar and Nagar Haveli & Daman and
Diu scored the highest (28 points), whereas the remaining four States scored
between 20 and 26 points.
Insights from State-level key findings on the two sub-themes of coverage of programme
activities for health are as follows:
a. Programme Activities
A total of 12 indicators were used to assess progress on health-related programme
activities.
State-level key findings:
ÂAmong all 34 States and UTs, 27 had more than 75% of newborns who were
breastfed within one hour, whereas Rajasthan, Ladakh and Puducherry had less
than 25%.
38
What progress have we made to date?
ÂOnly 17 States and UTs had more than 75% of children 12-23 months of age who
were fully immunised, while 11 states and UTs had less than 25% children who
were fully immunised.
ÂIn terms of children 6-59 months of age provided at least 8-10 doses of IFA
syrup, only Himachal Pradesh, Sikkim, and Puducherry covered more than 75%
of children while as high as 23 States and UTs had less than 25% coverage.
ÂOnly 13 states and UTs had more than 75% of pregnant women registered for
ANC in the first trimester. 19 States had more than 75% of pregnant women who
had 4 or more ANC visits. Punjab, Nagaland and Tripura had less than 25% of
pregnant women attending 4 or more ANC visits.
Â23 States and UTs had more than 75% of pregnant women who were given 180
IFA tablets, while Punjab and Tripura had less than 25% coverage of IFA for
pregnant women. On the other hand, 12 States and UTs had more than 75% of
lactating women who were giving 180 IFA tablets, while 9 States and UTs had
less than 25% coverage of IFA for lactating women.
Figure 18: State-wise scores for Programme activities and intervention coverage-
Health Department
Maximum score: 38
ÂThe percentage of children who were given weekly IFA tablets is low: only 6
States and UTs had covered more than 75% of children, and coverage is less
than 25% in 12 States and UTs.
ÂIn terms of percentage of pregnant women given TT2/Boosters, 21 states had
more than 75% coverage of TT2/Boosters, yet Punjab and Tripura had less than
25% of pregnant women who were given TT2/boosters.
ÂThe percentage of pregnant women who were given 1 Albendazole tablet after
first trimester is low, as only 5 States and UTs had more than 75% coverage,
while 10 States and UTs had less than 25% coverage.
What progress have we made to date?
39
Â16 States and UTs had more than 75% of children (0-59 months) diarrhoea cases
treated with ORS, while there were 5 States and UTs that treated less than 25%
child diarrhoea cases with ORS.
Â15 States and UTs reported more than 75% of home visits for pregnant mothers
to counsel them on practices during pregnancy, whereas less than 25% of home
visits for pregnant women were conducted in Madhya Pradesh and Arunachal
Pradesh during the COVID-19 pandemic.
Many States and UTs were unable to provide information on all indicators, and information
was not available for any indicator for Mizoram. Annexure 6-F lists the best and the worst
performing States/UTs on the 14 programme activity indicators.
Overall, there is scope for improvement in coverage for interventions during the first 1,000
days. Interventions like early initiation of breastfeeding, 180 days IFA received by pregnant
women, and TT2/boosters received by pregnant women have acceptable coverage
across States and UTs. Interventions like child immunisation (12-23 months), women who
registered for ANC during the first trimester, women who attended 4 ANC visits, and
reported diarrhoea cases that were treated with ORS had performed well in some States
and UTs, but gaps still exist in Bihar, Jharkhand, Kerala, Punjab, Rajasthan, Telangana,
Uttarakhand, north-east States and UTs. There is a need to focus on interventions like IFA
syrup received by children (0-59 months), IFA received by lactating women and pregnant
women who received albendazole tablet after first trimester, as many States have less
than 25% coverage of these indicators.
b. AMB Strategy
Two indicators were used for assessing progress on the AMB strategy.
State-level key findings:
According to the data collected from the States and UTs, 27 States and UTs have included
IFA in the Essential Drug List, while the process is underway in 7 States and UTs. The
results show that 9 states have procured digital invasive haemoglobin meters, while the
process is in progress in as many as 22 States and UTs. The process is yet to begin in
Karnataka, Andaman and Nicobar Island, and Dadar and Nagar Haveli & Daman and Diu.
Information was not available for Mizoram for both indicators.
3.2 CONCLUSION AND WAY FORWARD
This chapter assessed State progress on establishing a range of mechanisms to deliver
all POSHAN Abhiyaan components (technology, behaviour change communications,
capacity building and convergence).
Overall, there is mixed progress among States across multiple indicators on establishing
mechanisms to implement POSHAN Abhiyaan, reinforcing the need to bridge gaps in
many areas. The key findings and subsequent recommendations are as follows:
40
What progress have we made to date?
ÂOverall, fund utilization is low, with less than 50% of funds utilised in 23 States
and UTs. Thus, there is an immediate need to accelerate its use through channels
like recruiting human resources, procurement of devices and conducting CBEs
and IEC.
ÂThe constitution of district and block-level convergence action plan committees
is not uniform across all States and UTs. This has implications for preparation
of convergence action plans, which is the roadmap for achieving convergence.
As empirical evidence suggests that implementing interventions across sectors
simultaneously reduce stunting
5
; therefore, formation of CAPs is of utmost
importance.
ÂMany States and UTs have also submitted CAP to CPMU, but there is a need
to focus on operationalizing the plans in a way that the interventions across
sectors reaches same beneficiaries. Outcome-oriented convergence on ground
can also be facilitated by training the field level staff on sharing information and
data among themselves.
ÂState scores varied across the service delivery indicators including on HR,
infrastructure, supplies, training and capacity building. To continue progress
on POSHAN Abhiyaan, attention to state-specific challenges pertaining to
insufficient human resources, supplies and infrastructure is required.
ÂTo close the gaps on procurement of smartphones, the Anganwadi Workers
(AWWs) can be incentivized for data entry on online application or providing
monthly allowance for rental/usage for using their own devices, as an alternative.
ÂIn addition, there are large gaps in staff training on e-ILA modules across several
States, due to low attendance at training, unavailability of training materials, lack
of trainers, and low educational background of AWWs2. Therefore States/UTs
need to address these challenges.
ÂAmong the many ICDS services, priority areas for capacity building include
strengthening the quality of growth monitoring and home-based counselling.
ÂStates and UTs had covered many beneficiaries for THR, yet gaps exist. Therefore,
there is a need to assess whether the gaps in THR pertain to supply chain issues
or demand-side challenges. To address supply-side challenges, de-centralized
model and decentralized self-help group model can be explored. E-payments
should also be introduced at every stage. To address demand-side challenges,
PRI and self-help groups (SHGs) should be involved for community engagement
and explaining benefits. Additionally, to increase nutritional status and reduce
intra-household consumption, fortification of THR and differentiating the packets
for pregnant and lactating women, and children is recommended. With the
introduction of POSHAN Tracker, the tracker should be used to monitor the
nutrition service delivery of THR through QR code-based check while distributing
packets and maintaining inventory. The tracker should also be used to monitor
food consumption and take concurrent feedback from beneficiaries.
5 Rajpal et. al 2020
What progress have we made to date?
41
ÂProgramme activities conducted under Department of Health have a mixed
performance across the States and UTs. There is low coverage of IFA
supplementation across the life stages, due to which it requires special attention.
Similar to Kerala, other States and UTs can also implement programmes where
IFA is provided to the out-of-school children at the AWC. Additionally, there is a
need to assess the challenges on the supply-side and demand-side to improve
coverage, especially of IFA supplementation, Albendazole tablets during
pregnancy, 4 ANC check-ups, and home visits for pregnant women.
ÂA new institute called Jan Arogya Samiti (JAS) should be utilized to the fullest
in ensuring the accountability in the services being provided at the HWCs, and
for ensuring that the benefit reaches to all beneficiaries.
ÂThere is a need to strive for data management at the State and the UT level in
order to track their standing with respect to the objective of the Abhiyaan as
well as to enable inter-state comparison on performances.
These conclusions resonate with the Development Monitoring and Evaluation Office
(DMEO) of NITI Aayog’s earlier independent evaluation which identified challenges
of low fund utilisation, high numbers of staff vacancies limiting effective programme
implementation as well as implementation of training and mentoring of frontline workers
3
.
42
What progress have we made to date? 4 Jan Andolan and
Multi-Sectoral
Interventions
4.1 BACKGROUND
POSHAN Abhiyaan aims to reduce stunting, anaemia and low birthweight in districts with
a high burden of malnutrition. It recognizes the need for convergence and coordination
such that the benefits of government schemes and programmes reach women and
children in the first 1,000 days. The POSHAN Abhiyaan identifies targeted determinants
of nutritional outcomes that exist in various schemes and programmes. These include
maternal nutrition, newborn care practices, infant feeding and care practices and
underlying determinants, such as age at marriage, age at first birth and sanitation.
To eliminate malnutrition from India, implementing a package of interventions with
adequate coverage, continuity, intensity and quality must be ensured. To this end, POSHAN
Abhiyaan was scaled up based on several key pillars, including technology, improving
capacities, convergence of multiple programmes and behaviour change communication.
These pillars were introduced to trigger a series of changes that improve nutrition
interventions in the ICDS and health systems, address the immediate and underlying
determinants of poor nutritional outcomes, and help improve outcomes such as child
growth, lower anaemia and other targets of the nutrition mission.
This chapter presents the community involvement in POSHAN Abhiyaan through Jan
Andolan 2020, and highlights the multi-sectoral steps taken by various Line Ministries
for POSHAN Abhiyaan in FY 2019-2020.
4.2  JAN ANDOLAN
The Honourable Prime Minister intended that the POSHAN Abhiyaan be converted into
a Jan Andolan for effective outreach and implementation. The Mission strives to prevent
and reduce undernutrition, LBW, and stunting across the life cycle as early as possible,
especially in the first three years of life, with interventions up to six years of age. Several
programmes across Ministries and Departments have been contributing to tackling
43 malnutrition and anaemia in the country. POSHAN Abhiyaan seeks to synergise all these
efforts to achieve the desired goals and intends to raise community-level awareness into
a Jan Andolan.
Objectives: Jan Andolan aims to achieve the following objectives:
ÂRaise awareness on the impact of malnutrition across sectors and, in turn, create
a ‘call to action’ for each sector to contribute towards reducing malnutrition;
ÂMobilise multiple sectors and communities to consume more nutrient-rich food;
and
ÂPromote knowledge, attitudes and behaviours that support optimal breastfeeding,
complementary feeding, maternal nutrition and adolescent nutrition to prevent
malnutrition, including severe acute malnutrition (SAM) and anaemia.
4.2.1  Poshan Maah
In September 2020, Poshan Maah demonstrated the power of convergent outreach,
garnering a gross participation of 379 crore participants across 14 crore activities
nationwide. As many as 102 crore men, 128 crore women, and 118 crore children (males
and females) were reached through Poshan Maah-related activities. However, it may be
noted that this participation consists of repeat and recurrent participants, and should
not be treated as absolute number of participants.
Despite the COVID-19 pandemic, there was tremendous enthusiasm and impressive
participation in various activities were observed across the country. Considering the
current pandemic, various activities were conducted through digital platforms for
celebrating the Poshan Maah. Social Media, online activities, podcasts, e-Samvaad, and
multiple webinar series were the most extensively used platforms.
Compared with Poshan Maah 2019, participation increased by 51% and the number of
activities conducted by 284%, indicating an impressive rise in outreach and engagement
associated with Poshan Maah 2020.
The States with the most activities conducted and highest participation levels in Poshan
Maah 2020 are Tamil Nadu, Maharashtra, Uttar Pradesh, Bihar, Gujarat, Karnataka and
Madhya Pradesh.
44
Jan Andolan and Multi-Sectoral Interventions POSHAN MAAH (SEPTEMBER 2020)
National Participation
ffi fi‟3,‟fiffi‟6,,5
Adult Participation
ffi fi‟3,6546,,645678 ‟ffi fi‟3,646476564
Children Participation
ffi fi‟3676786, ‟ffi fi‟3467,6868, Figure 19: Poshan Maah performance by participation across India, 2020
Note: The number of participants include repeat and recurrent participation
The State-level performance of participation in Poshan Maah was computed based on
an index that includes factors like total activities, number of AWCs and the number of
activities in the States/Districts. Figure 19 summarises the total number of activities and
participation under Poshan Maah nationwide.
POSHAN MAAH
20192020
Activities
3,66,54,719 14,08,22,709
20192020
Total Participation
2,51,39,88,802 3,79,64,93,044
Figure 20: Poshan Maah performance by participation: Comparison between 2019 and 2020
Jan Andolan and Multi-Sectoral Interventions
45 All Ministries facilitated convergence through formal circulars and specific instructions to
their line departments in the States and Districts across themes to fight malnutrition. This
year, Poshan Maah’s primary themes were identifying and tracking children with SAM and
promoting kitchen gardens. Figure 21 lists other themes covered under POSHAN Maah
2020. Many Chief Ministers and various state and district officials have taken a pledge
to end malnutrition and made it a personal agenda to monitor the progress regularly.
211%%
1100%%
77%%
66%%1122%%
66%%
4%
1100%%
110%
44%%
55%
5%
00%%
5%%%%%%%%%%%%
00%%
THEMES
Poshan (Overall Nutrition)
Breastfeeding
Compl. Feeding
Immunisation
Growth Monitoring
Food Fortification & Micronutrients
Diarrhoea
Hygiene, Water, Sanitation
Anemia
Adolescent Ed, Diet, Age of Marriage
Antenatal Checkup
ECCE
Online Essay Competition
Plantation
Figure 21: Themes covered under POSHAN Maah, 2020
4.2.2  Convergence of line ministries during Jan Andolan
Various line ministries, including the Ministries of Health and Family Welfare, Drinking
Water and Sanitation, Rural Development, Human Resource and Development, Information
and Broadcasting, Panchayati Raj, Tribal Affairs, Housing and Urban Affairs, Electronics
and Information Technology, Minority Affairs, Ayurveda, Yoga, Naturopathy, Unani, Siddha,
Sowa-Rigpa and Homoeopathy (AYUSH), Youth Affairs and Sports, Social Justice and
Empowerment, Ministry of Agriculture Cooperation and Farmers Welfare and Ministry of
Consumer Affairs, Food & Public Distribution partnered with the MoWCD during Poshan
Maah. Grass-root level platforms like Gram Sabhas, SHGs, and field functionaries across
various ministries and schemes were used for optimum spread and coverage. Table 5
describes the key activities performed during Poshan Maah by line ministries.
46
Jan Andolan and Multi-Sectoral Interventions Table 5: Key activities performed during Poshan Maah by Line Ministries
MINISTRYACTIVITIES
Ministry of Women and
Child Development
The Ministry conducted numerous activities, which included rallies,
marathons, Pad Yatra, Cycle Yatra, cultural programmes, Nukkad
Nataks, short film shows, exhibitions, and online competitions on
nutrition, health, immunisation, and sanitation and health for the
celebration of Poshan Maah.
The Ministry held four webinars in September. The first webinar
featured discussions on the need for a renewed focus on nutrition
during COVID-19, the need for innovation and agro-diversity in
nutrition, sharing of best practices and success stories in establishing
nutri-gardens in Lakshadweep AWC, online tracking and adoption of
Severely Malnourished Children in Gujarat, revamping supplementary
nutrition preparation and distribution and inclusion of Millets in Odisha,
adoption of SAM children by Government Officials in Uttrakhand,
and identification drive for SAM children in the UTs of Dadar and
Nagar Haveli, and Daman and Dui. The second webinar focused
on the Nutrient Requirement for Children and Mothers during the
first 1,000 days. The third webinar focused on the importance of
sound bone health among Indian children, adolescents, pregnant
women, and lactating mothers, and the fourth webinar outlined the
prevention and management of enteric infections in 5-14-year-old
school children and gave details about the incidence of deaths and
Disability-adjusted life years lost due to such infections.
On 20 September 2020, the Ministry signed a Memorandum of
Understanding with the Ministry of AYUSH for integrating AYUSH
systems with ongoing nutrition interventions under the ICDS
programme, developing medicinal gardens in identified AWCs and
conducting Yoga Classes for women and children at all AWCs.
Ministry of Health and
Family Welfare
Amid the COVID-19 pandemic, the ‘Rashtriya Poshan Maah’ was
celebrated in the States and UTs abiding by the norms of social
distancing and avoiding mass gatherings. Many States/UTs
conducted deworming campaigns under the NDD programme during
the ‘Rashtriya Poshan Maah’. Albendazole tablet was administered
through house-to-house visits for the first time under the NDD
programme. The diarrhoea prevention and management activities,
and the VHSNDs were also celebrated in the various States/UTs.
The States and UTs conducted virtual orientation of the staff and
also conducted webinars on the importance of the first 1,000 days
of life, anaemia prevention, and breastfeeding and IYCF practices.
Children with SAM who were treated were discharged from NRCs
and followed up over the telephone. Kitchen gardens/nutri-gardens
establishment was also focused in some States. As per the Jan-
Andolan dashboard, 3.77 crore persons participated in 8.1 lakh
activities conducted by MoHFW and State Health Departments.
Jan Andolan and Multi-Sectoral Interventions
47 MINISTRYACTIVITIES
Ministry of Consumer
Affairs, Food and Public
Distribution
A total of 1,043 activities were undertaken by the Central and
State level Department under the Department of Food and
Public Distribution, Ministry of Consumer Affairs, Food and Public
Distribution to celebrate Poshan Maah 2020. The activities included
awareness-raising on nutrition and diet diversification, plantation
drive of kitchen and nutri-gardens, cooking recipe competitions,
online essays, quizzes, slogans, debates, poster and drawing
competitions, webinars and panel discussions on malnutrition,
distribution of fortified foods and fruits to the underprivileged
women and children, and distribution of mixed micro green seeds.
4.3  MULTI-SECTORAL INVOLVEMENT
Nutrition is fundamental to human survival and development and is an essential foundation
of national development. The launch of POSHAN Abhiyaan has been a watershed
movement in the series of enhanced allocations, policy measures and advisories issued
by the Government of India towards the goal of eradicating malnutrition in the country.
The Abhiyaan has not only given momentum to existing programmes, reoriented policy
choices and aligned several sectors towards the common goal of eradicating malnutrition,
it has also been instrumental in instigating a range of policy actions under its ambit within
a short span of time.
While POSHAN Abhiyaan has an earmarked three-year budget of Rs. 9046.17 crore
from 2017-18, it is an overarching framework that seeks to leverage funds, functionaries,
technical resources and information, education, and communication (IEC) activities from
existing programmes and schemes such as the Integrated Child Development Services
(ICDS), PMMVY, National Heath Mission (NHM), Swacch Bharat Mission (SBM), National
Rural Livelihood Mission (NRLM), National Rural Employment Guarantee Assurance
(NREGA) and the Public Distribution System (PDS). The aim is to align the efforts of
every stakeholder in a direction that could positively impact nutrition outcomes.
POSHAN Abhiyaan is a multi-ministerial effort to address malnutrition through tackling
its many determinants by strengthening and converging actions to support nutrition in
many Ministries. Although efforts are led by the MoWCD, critical actions have also been
taken by the Ministry of Health and Family Welfare, Ministry of Consumer Affairs, Food
and Public Distribution, Ministry of Drinking Water and Sanitation, as well as others. The
summary of actions, as reported by the key Ministries, is provided below.
4.3.1  Ministry of Women and Child Development
The MoWCD has collaborated with other Ministries like Ministry of Health and Family
Welfare, Ministry of Youth Affairs and Sports, Ministry of Consumer Affairs, Food Public
Distribution, and Ministry of Jal Shakti. The following measures have been taken:
a. Ministry of Health and Family Welfare: The Ministry has been working on
Intensified Mission Indradhanush 2.0, which provides Pneumococcal Conjugate
Vaccines (PCV), Rotavirus Vaccines (RVV), National Deworming Day (NDD),
HBNC, Home Based Care for Young Child (HBYC), institutional deliveries, LBW,
48
Jan Andolan and Multi-Sectoral Interventions antenatal check-up, IFA supplementation, community and home distribution of
IFA supplementation, vitamin-A supplementation, and Rashtirya Bal Swasthya
Karyakram (RBSK) for meeting the objective of POSHAN Abhiyaan. During
the four rounds conducted under Intensified Mission Indradhanush 2.0 from
December 2019 to March 2020, around 37.09 lakh children and 7.41 lakh pregnant
women were vaccinated. Similarly, more than 49 lakh doses of PCV have been
administrated from January 2020 to April 2020, and more than 1.8 crore doses
of RVV have been administered from January 2020 to April 2020. NDD has been
conducted in 25 States and UTs and have covered around 11.3 crore children.
Under HBNC programme 46.92 lakh newborns received complete schedule
of home visits by accredited social health activists (ASHA), and 2.5 lakhs sick
newborns have been referred to health facilities. While under HBYC, out of 242
districts, 238 have completed trainers’ trainings, 1,60,339 frontline workers have
been trained, and around 1,83,975 children have received visits in 39 districts,
where 22 are Aspirational Districts.
According to the information shared by MOWCD, 94% of the total deliveries
reported were conducted in hospitals, 73.4% ANC check-ups were registered in
the first trimester, 80% of the pregnant women received 4 or more ANC check-
ups, 91% of the pregnant women were given IFA supplementation where the
IFA supplementation were home delivered extensively from January to March
2020, and 69.83 lakh children were provided with the first dose of Vitamin A
supplementation. Under RBSK, 1.2 crore children 0-3 years of age were screened,
and 3.16 lakh children availed services at secondary tertiary care institute, 1.07
crore children 4-6 years of age were screened, and 4.91 lakh children availed
services at secondary tertiary care institute.
b. Ministry of Consumer Affairs, Food and Public Distribution: The Ministry
has requested States to operationalize the blending of fortified rice and its
distribution through PDS, with a special provision for pregnant women, lactating
mothers, and children 6 months to14 years to free nutritious meal through ICDS
network and the Mid-Day Meal Scheme (MDMS). So far, 15 State Governments
agreed to implement the pilot scheme.
c. Ministry of Youth Affairs and Sports: The Ministry has launched the Fit India
Movement, which focuses on improving and promoting physical and mental
fitness, healthy lifestyles, preventive health care, sustainable and environment-
friendly living, including healthy and balanced diets.
d. Ministry of Safe Drinking Water: The Ministry has taken initiative to provide
an adequate quantity and quality of safe drinking water to public institutions
such as Gram Panchayat buildings, schools, AWCs, and health centres through
a functional household tap connection under ‘Jal Jeevan Mission’.
Additionally, MWCD emphasised improving the supplementary nutrition programme in
the States. With regard to hot cooked meals and THR, most States prepare a mix of
regional dishes and staple foods. Additionally, some States have been able to incorporate
fortified food items in the Supplementary Nutrition Programme. Some States offer sweets
like kheer, whereas others resort to offering a stipulated number of dry snacks with meals.
Jan Andolan and Multi-Sectoral Interventions
49 States have also taken the following measures for POSHAN Abhiyaan:
ÂTracking of severe underweight in Gujarat: The state has created a unique
identification number of the severe underweight children for follow up purposes.
Phone calls are being made for tracking of THR, monitoring home visits made
by the AWWs and getting feedback from programme guardians for tracking the
facilities received by severely underweight children.
ÂIdentifying drivers of SAM in Dadar and Nagar Haveli and Daman and Diu: The
State engaged District Collectors under the Department of Health and Family
Welfare to organize a drive to identify SAM cases. The drive covered four steps:
1) growth monitoring, 2) screening, 3) diet diversity and 4) counselling. The drive
measured 25,800 children out of 28,000.
ÂRevamping Supplementary Nutrition Programme in Odisha : The State has
engaged 548 SHGs in THR production and distribution, specifically in roasting,
weighing, packaging and distribution of grains. This engagement has mitigated
any programmatic disruptions as a result of the recent floods. Additionally,
the State has also formed a jaanch-committee at every AWC, which promotes
transparency.
‘Sarkar Aapke Dwar’ and ‘Sanjeevani’ Programme in Uttarakhand: The State has
launched the Sarkar Aapke Dwar initiative to sensitise people on malnutrition
and its ill effects on growth and overall development of the children. They were
also made aware of the totality of causes that can affect the health of a family.
The State has also launched Sanjeevani Programme, which provides ₹ 2000 per
month for 6 months to each SAM child.
Flexi Funds utilisation indicates that, on average, States/UTs have utilized 37% of the
funds earmarked to the States up until 31 March 2020. States have been utilising the
Flexi funds for organizing various events and camps that help in meeting the objective
of the Abhiyaan, capacity building and training of the AWWs, DPOs, CDPOs and State
Officials, procurement of various materials for AWCs, and incorporating technology for
effective implementation of POSHAN Abhiyaan. Annexure 4-A provides further details of
utilization of flexi funds States and UTs had also taken steps for strengthening the Hot
Cooked Meal Programme, and most States and UTs have also taken additional measures
to fortify the supplementary nutrition. Annexure 4-D provides state-wise details of the
supplementary nutrition programme.
Despite the continuous efforts in making India malnutrition free, MoWD has indicated
that the challenges with respect to training and capacity building of field functionaries,
and the gaps in infrastructure related to buildings, toilets, and drinking water facilities still
exist. The roll-out of ICDS-CAS and procurement of growth monitoring devices remains
have room for improvement, and there is low and delayed utilization of funds. Sustaining
‘Jan Andolan’ activities is also a major challenge for the Ministry.
4.3.2  Ministry of Health and Family Welfare
The National Health Mission (NHM) under the MoHFW plays a vital role in the success
of POSHAN Abhiyaan as both the missions share similar goals such as the reduction of
50
Jan Andolan and Multi-Sectoral Interventions undernutrition, anaemia and the prevalence of LBW. Various health sector interventions
that are instrumental in the success of POSHAN Abhiyaan include:
a. Home-Based Care of Young Child (HBYC): The HBYC programme involves
additional home visits over and above the existing HBNC visits for nutrition
promotion. Ministry has sanctioned an amount of Rs. 217.68 crore for the
programme to be implemented across 242 Districts including 112 Aspirational
Districts. As far as capacity building of frontline workers is concerned, 31 States/
UTs have completed the training of trainers, and 27 States/UTs have started
the training of frontline workers for HBYC. A total of 1,60,339 frontline workers
covering 179 districts across 26 States/UTs have been trained. Additionally, home
visits have started in 16 states covering 55 Districts including 31 Aspirational
Districts. The Ministry has further included 275 additional Districts under HBYC
in the FY 2020-21.
b. Home-Based New-Born Care (HBNC): A total of 1.42 crore newborns have
received home visits by ASHAs in 2019-20 and 5.68 lakh newborns have been
referred. The average HBNC home visit coverage has increased from 71.2% in
2018-19 to 78.6% in 2019-20, and around 90% of round 3 training of the ASHAs
has been completed.
c. Anaemia Mukt Bharat (AMB): Under the programme, central procurement of
IFA supplements has been made available, and the procurement for red and
blue IFA tablets is underway in 14 States/UTs. Considering the current COVID-19
pandemic, the comprehensive AMB training toolkit is being converted into an
e-learning module for online capacity building of the service providers and
programme managers. In FY 2019-20, 1.7 crore children 6-59 months of age
were provided weekly IFA syrup every month, and 2.8 crore children 5-9 years
of age were provided weekly pink IFA tablets every month. Similarly, 4.5 crore
children 10-19 years of age were provided blue IFA tablets every month, and 2.6
crore pregnant women and 1.4 crore lactating women were provided 180 IFA
red tablets in FY 2019-20.
d. National Deworming Day and Mission Indradhanush: In 2019-20, four rounds of
Intensified Mission Indradhanush were conducted from December 2019 to March
2020 in 381 identified districts of 29 States/UTs. In total, 1102.33 lakh (95%)
children were covered. States like Jammu and Kashmir, Meghalaya and Himachal
Pradesh conducted their first round of vaccination in October-November 2019
and covered 62.45 lakh children. Under various phases of Mission Indradhanush,
3.76 crore children and 94.6 lakh pregnant women have been vaccinated as of
March 2020. The full immunisation coverage for 2019-2020 is 92.83%, as per
the HMIS.
e. Intensified Diarrhoea Control Fortnight (IDCF) and severe acute malnutrition
(SAM) treatment in Nutritional Rehabilitation Centre (NRC): In 2019, families
of more than 10 crore under-five children were provided with ORS packets,
counselling on the use of ORS and zinc and proper nutrition during diarrhoea.
An estimated 75% of beneficiaries were covered during this period. Additionally,
Jan Andolan and Multi-Sectoral Interventions
51 as per FY 2019-20, there were 1,072 functional NRCs in 28 States, where 2.25
lakh sick SAM children received treatment.
f. Rashtriya Kishori Swasthya Karyakram (RKSK) and Ayushman Bharat School
Health and Wellness Programme: The RKSK counsellors and peer educators
have been involved in spreading awareness on nutrition. Additionally, information
on nutrition and health in schools with adolescent girls attending upper primary
senior secondary classes have been taken by rigorously by health and wellness
ambassadors (trained school teacher) as a part of Ayushman Bharat School
Health and Wellness Programme.
4.3.3  Ministry of Drinking Water and Sanitation
On Independence Day in 2014, the Honourable Prime Minister of India recognised the need
for affirmative action for a Swachh Bharat by 2 October 2019. The Mission’s resolution was
for a clean and Open Defecation Free (ODF) India by October 2019. As of March 2020,
a total of 706 Districts and 6.03 lakh villages were declared ODF, and 3.94 lakh villages
have been covered with piped water supply. Furthermore, the information provided by
States/UTs indicates that, out of 4,588 arsenic affected habitats, 319 have so far been
provided with safe drinking water. Moreover, out of 6,233 fluoride affected habitats, 830
have been provided with safe drinking water.
The Ministry has implemented Jal Jeevan Mission–Har Ghar Jal in partnership with
States to provide every rural household in the country to have potable water supply
through Functional Household Tap Connections by 2024. As of November 2020, the
mission has identified a total of 27,544 habitations, including 13,819 arsenic affected and
13,725 fluoride-affected rural habitations, to provide safe drinking water. To date, 3,647
habitations have been covered.
In addition to this, some States have taken the following initiatives:
ÂODF Plus activities galore in Kodagu, Karnataka: The district administration
of Kodagu in Karnataka has engaged in various activities to ensure ODF
sustainability. As a part of Swachh Sundar Shauchalaya, campaigns for creating
awareness on the importance of using toilets were held in schools, anganwadis,
and community public toilets. In addition, the district adopted the Pay-and-Use
model of community toilets so that funds could be gathered for painting the
toilets. On World Environment Day 2020, a campaign was held for Liquid Waste
Management and Solid Waste Management at household- and Gram Panchayat-
levels. Similarly, many mass awareness activities were planned, which included
Jathas or street plays, school competitions, clean-up campaigns, tree plantations,
marathons and debates, which raised awareness on ODF sustainability.
ÂSindhora becomes MP’s first Single-Use Plastic Free Gram Panchayat: With a
bartan bank in place, Sindhora Gram Panchayat in Indore District of Madhya
Pradesh became the State’s first single-use plastic free Gram Panchayat. The 70-
day campaign began in 425 households on 2 October 2019, and was implemented
by an all-woman team. Children, women, and other community members joined
52
Jan Andolan and Multi-Sectoral Interventions to clean the village, install dustbins at strategic places and plant saplings on
roadsides and public spaces. Meanwhile, school children carried out awareness
rallies and performed nukkad nataks. A door-to-door campaign, where cloth
bags were distributed to homes and residents were asked to refrain from using
plastic bags, was also carried out. A logo sticker was affixed to every house to
highlight their commitment of not using plastic. In addition, a bartan bank was
set up where a whole range of utensils could be borrowed at Rs. 1/- per piece
for marriages and other events to reduce the use of plastic.
4.3.4  Ministry of Consumer Affairs, Food, and Public Distribution
The Government of India has approved the centrally sponsored pilot scheme on
‘Fortification of Rice and its Distribution under PDS’ for three years beginning in 2019-
20, with a total budget outlay of Rs 174.64 crore. Fifteen State Governments—Andhra
Pradesh, Kerala, Karnataka, Maharashtra, Odisha, Gujarat, Uttar Pradesh, Assam, Tamil
Nadu, Telangana, Punjab, Chhattisgarh, Jharkhand, Uttarakhand and Madhya Pradesh—
have consented and identified their respective districts for implementation of the pilot
scheme. The States of Maharashtra, Gujarat Andhra Pradesh started distributing fortified
rice under the pilot scheme in February 2020, February 2020, and April 2020, respectively.
States of Tamil Nadu, Chhattisgarh, Kerala, Uttar Pradesh and Odisha are expected to
start soon.
In addition, the Ministry has issued a D.O. letter to the Secretaries of Food, Civil Supplies
and Consumer Affairs of all States/UTs emphasizing the nutritional benefits of fortified
edible oils. The Ministry has also requested all the States/UTs to distribute fortified wheat
flour as per Food Safety and Standards Authority of India (FSSAI) standards through
PDS in their respective States/UTs.
However, the Ministry has faced numerous challenges in implementing rice fortification.
Since the success of the pilot scheme depends on the rice millers, as the blending of
the fortified rice kernels with rice requires rice milling. Thus, bringing the private millers
to make investments for the same is a challenge that the Ministry is facing. Additionally,
under Targeted Public Distribution System (TPDS), about 350 lakh metric tonnes (LMT) of
rice is distributed and thus a total of 3.5 LMT of fortified rice kernels is required. However,
the availability of the fortified rice kernel stands at approximately 15,000 MTs/annum
currently. Furthermore, the capacity of the National Accreditation Board for Testing and
Calibration Laboratories (NABL)-accredited laboratories should be strengthened for the
successful implementation of rice fortification.
4.3.5  Initiative by Development Partners
In addition to the steps taken by the Development Partners for implementing POSHAN
Abhiyaan during COVID-19, development partners have actively undertaken the regular
activities for POSHAN Abhiyaan. Box 3 presents an example of one such project.
Jan Andolan and Multi-Sectoral Interventions
53 BOX 3: IMPROVING THE MICRONUTRIENT PROFILE OF THE
ICDS BENEFICIARIES
The United Nations World Food Programme (WFP) has taken many steps to
address the gap in the intake of micronutrients, especially in Kerala. Along with
the Department of Women and Child Development, Kerala, and the Kudumbashree
Mission – a federation of women’s self-help groups that produce take-home rations
(THR) under the ICDS. WFP has piloted projects on fortification of THR and the
rice-based hot-cooked meals served to children in Anganwadi Centres (AWC).
Under their project in Waynad, Kerala, the organisation has fortified the THR for
children 6-36 months, with 11 micronutrients consisting of calcium, iron, zinc, vitamin
A, thiamine, riboflavin, niacin, vitamin B6, vitamin C, folic acid and vitamin B12. The
pilot project started in the Mananthavady block of Wayand district, wherein WFP set
up a Nutrimix unit, developed awareness material to improve nutrition and feeding
practices among children 6-36 months of age, and trained officials for carrying out
fortification. Later, the project was scaled-up to all 14 districts, which also included
the distribution of IEC materials for improving nutritional intake, and the capacity
building and cascade training of Kudumbashree members. With the scale-up, over
4,00,000 beneficiaries are reached with fortified THR every month, and on average,
1,300 metric tonnes (MT) of fortified Nutrimix has been produced and distributed
monthly through 33,115 AWCs since May 2019.
Similarly, WFP and the Department of Women and Child Development, Kerala are
working towards mainstreaming rice fortification in the ICDS scheme in Kannur Kerala
for children 3-6 years of age. WFP facilitated the installation and commissioning
of a rice fortification unit in the Supply-Co facility at Thaliparamba in Kannur. The
rice received from FCI at SupplyCo is then blended with rice kernels containing
eight micronutrients, which are then distributed to Maveli Stores. In addition, the
Kudumbashree members are trained for the fortification process, withdrawing
samples for testing, and undertaking blending efficiency tests to ensure quality.
In January 2020, WFP trained 135 government officials on rice fortification, and
the team further addressed the queries of the officials on various aspects of rice
fortification. The project has fortified 86.6 MT of FCI rice, which has been distributed
across 915 AWCs reaching 14,100 children. Considering the success of the pilot
project, the project is now in the process of being scaled up across other districts
in Kerala.
Source: World Food Programme
4.4  CONCLUSION AND WAY FORWARD
The actions taken across Ministries to support India’s nutrition goals are commendable.
They take us closer to achieving the goals of effective convergence, and can support
convergent action planning. However, for maximum impact, diverse actions across
54
Jan Andolan and Multi-Sectoral Interventions Ministries must reach the last mile and ensure that all actions reach all households in the
first 1,000 days. To achieve this, we recommend the following:
ÂLocal innovations are essential to ensure that actions of MWCD and MoHFW
reach 1,000-day households fully so that each action/intervention is timed and
targeted appropriately and delivered with quality. This could require aligning
catchment areas and target populations at the local level, tracking of services
received and missed across both health and ICDS, and use of local data to support
co-coverage. Additionally, since MWCD and MoHFW use different applications
for tracking the same beneficiaries leading to duplication, therefore efforts are
required to develop a common platform for convergence of AWW, ASHA, and
ANM.
ÂCo-locate critical actions of all ministries in focus districts and focus blocks within
districts, especially those actions that address underlying causes of malnutrition
such as poor sanitation, gender issues, poverty, food insecurity. This again will
require local action
ÂConvergence and co-location will likely be more challenging in urban areas;
this will require close attention to local governance models in urban areas,
engagement of private providers and innovations around demand creation.
ÂThe 11th Schedule of Constitution lists 29 subjects within the functions of the
Panchayat. The schedule mandates PRIs to take measures for family welfare and
women and child development. Therefore, it is recommended that the PRI should
be involved in organizing and mobilizing beneficiaries through community-based
events.
ÂThere is also a need to design the activities and events in a way that they focus
on sustained capacity building of the eligible household through interpersonal
dialogue, rather than giving short-lived information. In addition to the FLWs, peer
educators, local NGOs/CSOs/community volunteer groups, such as NCC/NSS
students and women volunteers from SHGs should also be involved, as this will
achieve the dual objective of community engagement without compromising
home visits by FLWs.
Jan Andolan and Multi-Sectoral Interventions
55 Delivering POSHAN
Abhiyaan Interventions
during a Pandemic:
How are States doing?5
The COVID-19 pandemic disrupted progress on many activities in 2020, including the
delivery of health and nutrition services under the POSHAN Abhiyaan umbrella framework
of interventions. This chapter aims to quantitatively examine the impact of the pandemic
on the delivery of some of the POSHAN Abhiyaan interventions, drawing on publicly
available data. The restoration of key services over the course of the year is also examined.
Various activities conducted under MWCD and MoHFW were disrupted during the peak
of the lockdown period (April-June 2020). However, several policy adaptations and
interventions have been undertaken by central and State authorities to restore service
delivery. This section summarises the stringent actions taken by MoWCD and MoHFW
to prevent the spread of COVID-19, analyses the disruption in key health and nutrition
services, and reviews strategies adopted by States to continue service delivery amid
COVID-19.
For the purpose of examining the adaptations in response of COVID-19 pandemic, the
state policy guidance from March until October 2020 for 13 States (Andhra Pradesh,
Assam, Bihar, Chhattisgarh, Gujarat, Jharkhand, Karnataka, Madhya Pradesh, Maharashtra,
Odisha, Rajasthan, Uttar Pradesh and West Bengal) was assessed using the comprehensive
guidance issued by MoHFW and state-level documentation. To assess the impacts of
COVID-19 on the delivery of health and Integrated Child Development Services (ICDS),
MPR and HMIS State/UT-wise data were used for five quarters—that is, from October-
December 2019 to October-December 2020. Lastly, administrative data from State/UT
Template were utilised to highlight the innovative steps undertaken by the Department
of Women and Child Development (DWCD) and Department of Health for the provision
of services despite the COVID-19-related disruptions.
5.1 WOMEN AND CHILD DEVELOPMENT SERVICES
To curtail the spread of the pandemic, Anganwadi Centres (AWCs) were closed, and
services were disrupted. Operation of ICDS platforms including Anganwadi Centres,
57 VHSNDs, home visits, counselling and food supplementation for children, and pregnant
and lactating were examined for assessing the impact of COVID-19 on implementation
of these key women and child services.
5.1.1 Disruptions and policy adaptations of service delivery
platforms
During the strict lockdown months, AWCs were closed across states. In November 2020,
the MWCD issued guidance to open AWCs and resume services outside containment zones
by following COVID-19 safety protocols at the AWCs. VHSNDs were partly operational
in a few states following staggered approach and in non-containment zones. Routine
services were provided on-demand at health centres. In April 2020, the MoHFW issued
guidance on the delivery of health and nutrition services through home visits by FLWs.
Several states continued home visits and bundled essential services, such as distribution
of food supplements and counselling of beneficiaries, with home visits. This step was
taken by most states to ensure continuity of services (Figure 22).
State
Platforms
Interventions across life
stages
Anganwadi
centre open*
Village
Health &
Nutrition Day
Home visits Counselling
Food
supplemen-
tation
May Aug Sep/Oct May Aug Sep/Oct May Aug Sep/Oct May Aug Sep/Oct May Aug Sep/Oct
Andhra Pradesh                         
Assam                         
Bihar                         
Chhattisgarh                         
Gujarat                         
Jharkhand                         
Karnataka                         
Madhya Pradesh                         
Maharashtra                         
Odisha                         
Rajasthan                         
Uttar Pradesh                         
West Bengal                         
*In November 2020, national guidance was issued to open Anganwadi centers.
No information
Partly operational (i.e., for some groups of population or
geographic restrictions)
Fully operational
Service suspended

Figure 22: Policy guidance for implementation platforms and interventions across life stages
58
Delivering POSHAN Abhiyaan Interventions during a Pandemic: How are States doing? 5.1.2 Insights on disruption and restoration of supplementary
nutrition during COVID-19 pandemic
To assess the impact of COVID-19 on ICDS service delivery, State/UT-wise quarterly data
were used for five quarters—that is, from October-December 2019 to October-December
2020—on two indicators:
1. Number of children 6 months to 6 years old who received supplementary
nutrition; and
2. Number of pregnant and lactating women who received supplementary nutrition
Analyses of disruptions and restorations on ICDS services were conducted using data
from the ICDS monthly progress reports (MPR), provided by MWCD. The number of
beneficiaries at the national-level for each quarter was calculated by adding the number
of beneficiaries for all States and UTs. For assessing the change, the quarters were
divided into pre-pandemic period (October-December 2019), disruption period (April-
June 2020), early restoration period (July-September 2020) and restoration period
(October-December 2020). Section 2.5.2 provides more information on the methodology
for analysing the data.
Key findings from changes in coverage of supplementary nutrition
The number of beneficiaries who received supplementary nutrition declined during the
lockdown period, which suggests that services were disrupted. The coverage of food
supplementation for children 6 months to 6 years of age and pregnant and lactating
women was disrupted slightly during the lockdown period. According to the MWCD
mandate, food supplements were to be delivered to beneficiary households during the
lockdown, which mitigated disruptions. Between the fourth quarter of 2019 (October-
December 2019) and the second quarter of 2020 (April-June 2020), the coverage of
supplementary nutrition dropped by 2% and 3% for children and for pregnant and
lactating women, respectively.
Compared with the pre-pandemic period (October-December 2019), coverage increased
during the third quarter (July-September 2020) by 6% for children and by 2% for
pregnant and lactating women. This suggests that coverage of supplementary nutrition
programme (SNP) was gradually recovering. However, the coverage of supplementary
nutrition declined in the fourth quarter (October-December 2020), which was lower than
the pre-pandemic period.
Delivering POSHAN Abhiyaan Interventions during a Pandemic: How are States doing?
59 Figure 23: Changes in supplementary nutrition as per MPR data, October 2019 to
December 2020
Source: Monthly Progress Report Data, Ministry of Women and Child Development
At the State-level, the number of children 6 months to 6 years of age who received
supplementary nutrition reduced in 8 States and UTs in April-June 2020 compared with
the pre-pandemic period (October-December 2019) (Figure 24). However, despite the
lockdown, the coverage of supplementary nutrition was greater than or equal to the
pre-pandemic period in 28 States and UTs. During the July-September 2020 reference
period, the coverage of supplementary nutrition improved in 6 States/UTs where service
had been disrupted. In Madhya Pradesh, Goa and Delhi, the coverage was restored to
the pre-pandemic levels. By the end of the fourth quarter (October-December 2020),
coverage was greater than or equal to pre-pandemic levels in 32 States and UTs, but it
had declined substantially in Uttar Pradesh and Madhya Pradesh.
Compared with the pre-pandemic period (October-December 2019), the number of
pregnant and lactating women who received supplementary nutrition declined in 16 States
and UTs during the second quarter of 2020 (April-June 2020) (Figure 25). Conversely,
coverage increased or remained the same in 20 States and UTs. Early restoration efforts
were visible during the July-September 2020 period, as there was an improvement in
coverage of SNP in 10 States/UTs, which previously experienced disruption. Additionally,
Madhya Pradesh and Delhi recovered to pre-pandemic levels during this quarter. By the
end of the fourth quarter (October-December 2020), coverage in 23 States and UTs was
greater than or equal to pre-pandemic levels, but it declined in 11 States and UTs.
60
Delivering POSHAN Abhiyaan Interventions during a Pandemic: How are States doing? State/UTs
Disruption
(Q2 of 2020 to
Q4 of 2019)
Early Restoration
(Q3 of 2020 to Q4
of 2019)
Restoration (Q4
of 2020 to Q4 of
2019)
Large States
Andhra Pradesh 113%115%119%
Assam100%103%103%
Bihar68%76%102%
Chhattisgarh118%126%120%
Gujarat116%118%122%
Haryana130%133%136%
Himachal Pradesh 100%104%106%
Jharkhand75%67%87%
Karnataka111%109%113%
Kerala120%133%135%
Madhya Pradesh 52%112%85%
Maharashtra118%124%122%
Odisha113%114%114%
Punjab122%126%125%
Rajasthan105%108%128%
Tamil Nadu105%106%107%
Telangana108%112%119%
Uttar Pradesh94%96%41%
Uttarakhand116%121%107%
West Bengal114%118%120%
Small States
Arunachal Pradesh 100%100%100%
Goa99%100%106%
Manipur102%102%103%
Meghalaya98%99%99%
Mizoram117%125%108%
Nagaland111%111%110%
Sikkim120%127%132%
Tripura110%110%110%
Union
Territories
Andaman &
Nicobar
115%133%145%
Chandigarh98%94%106%
D & N Haveli &
Daman and Diu
117%129%124%
Delhi99%125%136%
Jammu & Kashmir 180%750%161%
Ladakh103%108%110%
Lakshadweep113%115%108%
Puducherry112%116%123%
All India98%106%97%
Key
>= 100%
<100% and >= 75%
<75% and >= 50%
<75% and >= 25%
<25%
Figure 24: Disruption and restoration of supplementary nutrition among children
6 months to 6 years of age during the COVID-19 pandemic, MPR data, October
2019 to December 2020
Source: Monthly Progress Report Data, Ministry of Women and Child Development
Delivering POSHAN Abhiyaan Interventions during a Pandemic: How are States doing?
61 State/UTs
Disruption (Q2
of 2020 to Q4 of
2019)
Early Restoration
(Q3 of 2020 to
Q4 of 2019)
Restoration (Q4
of 2020 to Q4 of
2019)
Large States
Andhra Pradesh108%111%111%
Assam100%101%101%
Bihar78%88%108%
Chhattisgarh112%119%113%
Gujarat95%99%100%
Haryana120%119%121%
Himachal Pradesh 97%97%96%
Jharkhand60%44%75%
Karnataka131%135%143%
Kerala118%121%112%
Madhya Pradesh50%112%81%
Maharashtra101%102%98%
Odisha108%109%109%
Punjab119%111%114%
Rajasthan119%111%129%
Tamil Nadu97%99%100%
Telangana122%131%131%
Uttar Pradesh94%92%39%
Uttarakhand105%105%93%
West Bengal115%116%117%
Small States
Arunachal Pradesh 100%100%100%
Goa89%86%82%
Manipur102%103%104%
Meghalaya83%83%82%
Mizoram98%99%86%
Nagaland101%101%101%
Sikkim162%174%171%
Tripura105%105%105%
Union
Territories
Andaman & Nicobar 116%136%138%
Chandigarh77%92%96%
D & N Haveli &
Daman and Diu
96%83%80%
Delhi93%112%118%
Jammu & Kashmir 186%161%148%
Ladakh95%98%97%
Lakshadweep96%99%103%
Puducherry92%99%95%
All India97%102%91%
Key
>= 100%
<100% and >= 75%
<75% and >= 50%
<75% and >= 25%
<25%
Figure 25: Disruption and restoration of supplementary nutrition among pregnant
and lactating women during pandemic, MPR data, October 2019 to December 2020
Source: Monthly Progress Report Data, Ministry of Women and Child Development
62
Delivering POSHAN Abhiyaan Interventions during a Pandemic: How are States doing? Overall, services were disrupted during the lockdown period (April-June 2020), and were
eventually restored between July and September 2020. The improvement in SNP services
may be attributed to the rigorous steps taken by States and UTs for increasing the
provision of take-home rations in response to the pandemic. Although coverage reduced
during October-December 2020, coverage was about 90% of what was achieved during
the pre-pandemic period.
5.1.3 State innovations in delivering ICDS services (core POSHAN
Abhiyaan Interventions)
States adopted different strategies to continue service delivery amid COVID-19. These
adaptations varied geographically and by type of service. Most states adapted to ensure
that the core ICDS services continued to reach all beneficiaries. Out of 32 states/UTs
for which State data were received, 28 states/UTs reported making some adaptations/
innovations to ensure service delivery. Table 6 summarises the type of innovations at the
State/UT-level, by services.
Table 6: Summary of ICDS programme delivery innovations in the context of
COVID-19, as reported by State Governments
State/UTs
SNP:
Additional
foods
Innovations
for growth
monitoring
Innovations
for
community-
based events
Innovations
for
counselling
Innovations
for pre-
school
education
Andaman
& Nicobar
Islands
Milk
At AWC &
and during
home visits
In staggered
approach
Home
visits and
consultation
through tele
calling
Home visits
Andhra
Pradesh
Special
supplements
for SAM
children
Staggered
approach in
AWC
Virtual CBEs
Home visits
and virtual
counselling
Virtual
classes
Arunachal
Pradesh
Eggs
Random
sampling
in AWC to
identify and
manage
cases of SAM
In staggered
approach in
AWC
Home visits
for vulnerable
groups
Parents
counselled
during home
visits
AssamHome visits
Video
conferencing
Virtual
classes
Bihar
Chandigarh
Dry ration &
cooked foods
to people in
need (March
to June only)
Home visits Virtual CBEs
Video
messages,
posters and
calling
Phone-based
activities
Delivering POSHAN Abhiyaan Interventions during a Pandemic: How are States doing?
63 State/UTs
SNP:
Additional
foods
Innovations
for growth
monitoring
Innovations
for
community-
based events
Innovations
for
counselling
Innovations
for pre-
school
education
Chhattisgarh
Dry rations,
eggs and
vegetables
During home
visits and
VHSNDs
During home
visits and in
community
spaces
Video clips
shared over
social media
Virtual
classes
DNH & DD
Special local
preparations
In staggered
approach in
AWC
During home
visits
Phone-based
activities.
Learning
material
distributed
Delhi Iron-rich THR
During home
visits
Virtual CBEs
During home
visits
Phone-based
activities
Goa
Micronutrient
supplements
for children
3 to 6
years and
adolescent
girls
Through
WhatsApp
GujaratVirtual CBEs
Local TV
channels
Haryana
Skimmed
milk powder
SAM children
weighed at
home
In staggered
approach in
AWC
During home
visits and
in shelter
homes for
migrant
population
Children
of migrant
labourers
provided
pre-school
education
Himachal
Pradesh
Staggered
approach in
AWC
Use of mobile
phones
Jammu &
Kashmir
Jharkhand
Karnataka
Milk and eggs
Spot feeding
for PW/LW
During home
visits
Virtual
classes and
radio
Kerala
Dry rations
& delivery
of food for
quarantined
homes
During
VHSNDs
Virtual CBEs
WhatsApp
based
broadcast
system-
POSHAN vani
Virtual
classes and
through local
TV channels
Ladakh
64
Delivering POSHAN Abhiyaan Interventions during a Pandemic: How are States doing? State/UTs
SNP:
Additional
foods
Innovations
for growth
monitoring
Innovations
for
community-
based events
Innovations
for
counselling
Innovations
for pre-
school
education
Lakshadweep Dry rations
Staggered
approach in
AWC
During home
visits
Madhya
Pradesh
Dry rations
Staggered
approach
during home
visits and
VHSNDs
Through
calling and
WhatsApp
Maharashtra
Once a
week/2 week
visit to SAM/
MAM children
by AWW
Virtual CBEs
Through
calling and
WhatsApp
Virtual
classes
ManipurTemplate not received
MeghalayaTemplate not received
Mizoram
Vegetables
from nutri-
gardens
Conducted
at AWC &
and during
home visits
Through
calling and
WhatsApp
Learning
material
distributed;
parents
given virtual
instructions
NagalandTemplate not received
Odisha Dry rations
During
VHSNDs and
home visits
In staggered
approach in
AWC
During home
visits
Virtual
classes
Puducherry
During home
visits and in
community
spaces
Home visits
and use of
television
PunjabHome visits
Virtual
classes
Rajasthan Dry rations
Use of mobile
phones
Sikkim
In staggered
approach in
AWC
Home visits
Tamil Nadu
Virtual
classes
Telangana
Bananas and
special local
preparations
Home visits
Virtual
classes and
through local
TV channels
Delivering POSHAN Abhiyaan Interventions during a Pandemic: How are States doing?
65 State/UTs
SNP:
Additional
foods
Innovations
for growth
monitoring
Innovations
for
community-
based events
Innovations
for
counselling
Innovations
for pre-
school
education
Tripura
Eggs, jaggery
and milk for
SAM children
Growth
monitoring
conducted
during home
visits
During home
visits
Home visits
Learning
material
provided
during home
visits
Uttar
Pradesh
During
VHSNDs
Home visits
Uttarakhand
Eggs, milk
and bananas
for 3-6-year
olds
Home visits Home visits
Video
conferencing
Virtual
classes
West
Bengal
Template not received
Source: Reported by States in response to questionnaires sent by NITI Aayog in September 2020
Note: (1) Dry ration includes rice, wheat, and pulses. (2) All the activities conducted in-person at AWC, homes
or community spaces followed COVID-19 protocol.
Foods in addition to the standard take-home rations
Several States provided specific foods in addition to the standard THR. Most states
provided dry rations (e.g., rice, wheat, pulses), whereas some provided milk, eggs or
other local preparations. Mizoram provided harvests from nutri-gardens. In most states,
all ICDS foods were delivered to homes.
Growth monitoring
During the stringent lockdown period and after it was relaxed, some States continued to
conduct growth monitoring, primarily for children affected by severe acute malnutrition
(SAM) and moderate acute malnutrition (MAM). Several states conducted growth
monitoring in AWCs, during VHSNDs and during home visits following the COVID-19
protocol. Maharashtra ensured visits by AWWs to SAM/MAM children once a week or
once every two weeks.
Community-based events
Community-based events (CBEs) resumed gradually after the lockdown was relaxed. In
several states, CBEs were transitioned to be conducted during home visits as well as in
AWC, maintaining COVID-19 protocols.
Counselling
Several states used phone calls and applications to continue counselling amid the
pandemic. Counselling services were also provided during home visits in several states.
Two states (Assam and Uttarakhand) used video conferences as a medium to deliver
counselling messages. One UT (Puducherry) used the local television channel to share
counselling messages.
66
Delivering POSHAN Abhiyaan Interventions during a Pandemic: How are States doing? Pre-school education
States/UTs primarily relied upon virtual media and phone-based activities to deliver pre-
school education. Three states/UTs (Dadra & Nagar Haveli & Daman & Diu, Mizoram and
Tripura) ensure distribution of learning materials during home visits. Three states (Gujarat,
Kerala and Telangana) used local television channels to telecast the curriculum.
BOX 4: STUDY TO ASSESS THE THR PRODUCTION AND
DISTRIBUTION ACROSS 12 DISTRICTS IN JHARKHAND AND
RAJASTHAN
Due to the disruption in the food systems amid the COVID-19 pandemic, NITI
Aayog, IDInsight and CIFF conducted a study to assess the THR production and
distribution across 12 districts in Jharkhand and Rajasthan. The first round of surveys
was conducted in January 2020 and the second round of surveys was conducted
in July-August 2020. Under the study, a qualitative survey was conducted over
phone with 114 respondents, which included 15 pregnant women, 13 mothers of
children aged 0-6 months, 26 mothers of children aged 6-36 months, 54 Anganwadi
Workers, and 6 SHG Members. Pregnant women and mothers were surveyed to
understand the demand-side challenges, whereas AWWs and SHGs were surveyed
for identifying the supply-side challenges.
According to the study, there has been a 12 percentage point drop in THR access in
Jharkhand and a 5 percentage point drop in THR access in Rajasthan from January
2020 to May 2020. In Jharkhand, the demand-side actors indicated that there has
been an irregular supply of the THR, while many of the beneficiaries were unable to
receive the THR since April 2020. Most of the AWW also indicated that they were
unable to distribute the THR since April or earlier, and only few AWW distributed
THR in July or August. In addition to COVID-19, the reasons for irregular supply of
the THR was because SHGs are not reimbursed timely for the previous deliveries, the
price of the raw materials have increased even as reimbursement rates remain fixed,
and there have been delays in receiving beneficiary lists from AWWs especially since
the lockdown. In Rajasthan, half of the interviewed beneficiaries did not receive THR
during lockdown. AWWs also indicated that they missed at least 1 month of THR
distribution since the lockdown. Rajasthan also faced challenges like insufficient
supply of THR at PDS, delays in reimbursement to AWW for transportation of THR,
and difficulty in transporting big packets of THR from suppliers to Anganwadi
Centres which further aggravated due to COVID-19.
Addressing delays in funding and payments, providing procurement support, and
enhancing trust and communication between demand-side and supply-side actors
could help improve the access and distribution of the THR.
Source: IDInsight and NITI Aayog
Delivering POSHAN Abhiyaan Interventions during a Pandemic: How are States doing?
67 BOX 5: FRONTLINE HEALTH WORKERS ENABLE RESTORATION
OF HEALTH AND NUTRITION SERVICE DELIVERY AFTER EARLY
COVID-19 LOCKDOWN: FINDINGS FROM A SEVEN-STATE
OBSERVATIONAL STUDY
As the COVID-19 pandemic unfolded, countries took various actions including
stringent lockdowns, imposing travel restrictions, and mandating face masks to
stem the spread of the pandemic. Early during the pandemic, modelling studies
based on Lives Saved Tool (LiST) (Roberton et.al, 2020), suggested that closures
to health and nutrition services would have substantial impacts on maternal, child
health and nutrition outcomes.
In India, there was an early recognition of the importance of preserving essential
services. The first set of policy directives to restart essential nutrition and health
services were released in March and early April 2020. The early and adaptive policy
guidance signalled a strong intent to resume services rapidly, but little is known
about how this has played out on the ground. India drew on its strong cadre of
nearly 2.42 million health and nutrition frontline workers (FLWs) across the two
national flagship programmes–the Integrated Child Development Services (ICDS)
and the National Health Mission (NHM) –to deliver the services.
To understand how FLWs are responding to the government guidance and delivering
these interventions during the pandemic, phone surveys with 5,500 FLWs were
conducted in seven states (Bihar, Chhattisgarh, Madhya Pradesh, Odisha, Tamil
Nadu, Telangana and Uttar Pradesh) between August-October 2020, asking about
service delivery during April 2020 (T1) and in the August-October 2020 period
(T2). Changes were analysed between T1 and T2 periods.
The Anganwadi Centres (AWC) were not opened daily across the states in April
(T1). While nearly all FLWs in Telangana and 84% in Chhattisgarh reported opening
their AWCs daily, 49% in Bihar, 44% in Odisha, 18% in Uttar Pradesh and only 7%
in Tamil Nadu reported doing so. In the post-lockdown period (T2), a much larger
proportion of FLWs reported opening the centres. Fewer AWWs in Tamil Nadu (21%)
and Odisha (54.2%) reported opening the centres compared with other states.
In April, a majority of FLWs (65% to 100%) in all states distributed food supplements.
Nearly all FLWs in all states resumed the service in T2, except in Bihar where
only half of FLWs provided this service compared with T1 (Figure 2). Holding of
VHSND varied widely across the states in April, with the lowest by FLW Bihar
(1.5%) and Uttar Pradesh (9%), and the highest in Odisha (91%). In T2, conducting
of VHSND increased in all the states; 84 percentage point increase noted in Bihar,
78 percentage points in Uttar Pradesh and 58 percentage points in Tamil Nadu.
68
Delivering POSHAN Abhiyaan Interventions during a Pandemic: How are States doing? A majority of FLWs in five states conducted home visits (74% to 99%) during
the lockdown except for Bihar (51%) and Uttar Pradesh (32%). In T2, home visits
increased by 41 percentage points in Bihar and 59 percentage points in Uttar Pradesh.
Except in Uttar Pradesh (14%), >50% FLWs reported providing counselling on health
and nutrition in April and nearly all FLWs in all states reported reinstatement of
the service in T2. Between 40–85% FLWs in reported providing IFA supplements
to pregnant women in April, except in Bihar (11%). In T2, IFA provision increased
by 11 to 44 pp among states. In April, only 12–22% FLWs reported conducting
growth monitoring in five states, but service provision increased by 26–75 pp in
T2. In contrast, a majority of FLWs in Chhattisgarh and Odisha conducted growth
monitoring in T1 and T2. Except in Bihar (2%), >50% FLWs supported immunisation
services for children during the lockdown; service provision increased by 9–83
pp in T2. Majority of FLWs in Chhattisgarh (86%) and Odisha (91%) supported
immunisation services in April. In addition to delivering maternal and child nutrition
services, FLWs performed several COVID-19 specific duties. The challenges faced by
FLWs in delivering services varied by the state. Most FLWs reported personal fears,
walking long distances, and beneficiaries’ non-cooperation as challenges.
Source: Avula, R., P.H. Nguyen, S. Ashok, S. Bajaj, S. Kachwaha, A. Pant, M. Walia,
A. Singh, A. Paul, A. Singh, B. Kulkarni, D. Singhania, J.E. Alegria, L.F. Augustine,
M. Khanna, M. Krishna, N. Sundaravathanam, P.K. Nayak, P.K. Sharma, P. Makkar, P.
Ghosh, S. Mala, S. Jain, S.K. Banjara, S. Nair, S. Ghosh, S. Das, S. Patil, T. Mahapatra,
T. Forissier, T.N. Lewis, P. Nanda, S. Krishnan, andP. Menon. 2021. “India’s 2.42 million
frontline health workers enable restoration of health and nutrition service delivery
after early COVID-19 lockdowns: An observational study.” Unpublished, International
Food Policy Research Institute.
5.2 MATERNAL AND CHILD HEALTH SERVICES
There were disruptions to maternal and child health services delivered by the Departments
of Health during the pandemic. With the spread of COVID-19 virus, health care facilities and
frontline workers have primarily been involved in providing care to the COVID-19 affected
patients. However, to ensure the continuation of critical services at States/UTs irrespective
of COVID Status, the MoHFW has issued two guidance documents to the States/UTs viz.
enabling delivery of essential health services, including services to pregnant women. While
the first document provided provision of RMNCH+A (Reproductive, Maternal, Newborn,
Child and Adolescent) services with special focus, the second document mentioned that
under no circumstances should there be a denial of essential services.
We examined disruptions and policy adaptations pertaining to interventions during
pregnancy period, postnatal period, and early childhood periods were assessed to
evaluate the toll of the pandemic on maternal and child health services.
Delivering POSHAN Abhiyaan Interventions during a Pandemic: How are States doing?
69 5.2.1  Disruptions to service delivery and policy adaptations
Following the national guidance on essential maternal and child services, in April, several
states issued guidelines to provide antenatal care (ANC) services for on-demand and
walk-in beneficiaries at health facilities or to provide services only in some areas or
using mobile units for caring for pregnant women in migrant camps. Overall, only a few
States issued guidance on deworming during pregnancy. Only Bihar and Maharashtra
had early guidance on deworming by May 2020. Guidance on institutional deliveries
was available by May 2020 in 6 of 13 States. Following the national guidelines, a few
States issued guidelines to ensure safe institutional deliveries at all health facilities and
maintain due list of expected delivery dates for all pregnant women. Guidelines to provide
IFA supplements to pregnant and lactating women were issued in May 2020. States
provided IFA supplements either through home visits or through on-demand at health
facilities. A few states ensured delivery of IFA supplements to migrant workers visiting
the state due to the lockdown. By May 2020, guidance on provision of neonatal tetanus
protection was available in 11 of the 13 States. States issued guidelines to provide on-
demand immunisation services at health centres at the community-level and through the
outreach sessions.
For interventions during the early childhood period, guidelines were available in May
2020. Services like IFA supplementation and health check-up for SAM children were fully
functional across most states. Growth monitoring and immunisation services showed a
mixed picture with Gujarat completely suspending growth monitoring. Immunization was
either fully functional or partly available in 12 out of 13 states. Vitamin A supplementation
and provision of ORS/Zinc were fully implemented in few states and information is not
available for the remaining states.
State
Interventions during pregnancy & postnatal period
Antenatal care
Deworming
during
pregnancy
Institutional
deliveries
IFA supplemen-
tation
Neonatal
tetanus
protection
May Aug Sep/
Oct May Aug Sep/
Oct May Aug Sep/
Oct May Aug Sep/
Oct May Aug Sep/
Oct
Andhra Pradesh                             
Assam                             
Bihar                             
Chhattisgarh                             
Gujarat                             
Jharkhand                             
Karnataka                             
Madhya Pradesh                             
Maharashtra                             
Odisha                             
Rajasthan                             
Uttar Pradesh                             
West Bengal                             
70
Delivering POSHAN Abhiyaan Interventions during a Pandemic: How are States doing? State
Interventions during early childhood
Pediatric
IFA
Growth
monitoring
Immuniza-
tion
Vitamin A
supplemen-
tation
Health check
ups for SAM
children
ORS/Zinc
during
diarrhea
May Aug
Sep/Oct
May Aug
Sep/Oct
May Aug
Sep/Oct
May Aug
Sep/Oct
May Aug
Sep/Oct
May Aug
Sep/Oct
Andhra Pradesh                      
Assam                      
Bihar                      
Chhattisgarh                      
Gujarat                      
Jharkhand                      
Karnataka                      
Madhya Pradesh                      
Maharashtra                      
Odisha                      
Rajasthan                      
Uttar Pradesh                      
West Bengal                      
No information
Partly operational (i.e., for some groups of population or
geographic restrictions)
Fully operational
Service suspended

Figure 26: Policy guidance for interventions during pregnancy, postnatal and early
childhood period
5.2.2 Insights on disruption and restoration of interventions delivered
by the health system during COVID-19 Pandemic
Seven key interventions across the continuum of care were selected for an analysis of
disruptions and restorations. These include:
1. Number of pregnant women who were given 180 IFA tablets;
2. Number of pregnant women who received 4 or more ANC check-ups;
3. Number of institutional deliveries conducted (including C-Sections);
4. Women receiving 1st post-partum check-up between 48 hours and 14 days;
5. Number of newborns who received 6 HBNC visits after institutional delivery;
6. Number of children 9-11 months of age who received full immunisation;
7. Number of severely underweight children provided health check-up (0-5 years).
Delivering POSHAN Abhiyaan Interventions during a Pandemic: How are States doing?
71 Section 2.5.2 details the methodology used for assessing disruption and restoration for
five quarters—that is, from October-December 2019 to October-December 2020 at the
national- and state-levels. The periods were divided into pre-pandemic period (October-
December 2019), disruption period (April-June 2020), early restoration period (July-
September 2020) and restoration period (October-December 2020).
Key findings on changes in the coverage of pregnant women who received 180+ IFA
tablets and pregnant women who received four or more ANC check-ups
The number of pregnant women who received 180+ IFA tablets and the number of
pregnant women who received four or more ANC visits declined post-March 2020 to
lower than the pre-pandemic period by 13% and 24%, respectively (Figure 27). However,
the coverage of these services improved significantly post-June 2020, such that the
coverage of IFA and ANC visits was only slightly lower than pre-pandemic levels. Over
the entire period, the number of pregnant women who received IFA tablets exceeded
the number of pregnant women who received four or more ANC visits.
Figure 27: Changes in number of pregnant women received full course of 180 IFA
tablets, 4 or more ANC check-ups from October 2019 to December 2020
Source: HMIS publicly available data, Ministry of Health and Family Welfare
At the state-level, the number of pregnant women who received 180+ IFA tablets reduced
in 19 States and UTs, where decline in Uttar Pradesh, Manipur, Delhi, and Chandigarh
was highest (Figure 28). During the early restoration period (June-September 2020),
IFA coverage improved in 13 States/UTs, which previously experienced disruptions in
this area. Similarly, the situation further improved in October-December 2020 in many
States, and 22 States and UTs had coverage more than pre-pandemic levels. Coverage,
however, remained low in Manipur and Chandigarh. Data were not available for Ladakh
for all periods; thus, it was excluded.
72
Delivering POSHAN Abhiyaan Interventions during a Pandemic: How are States doing? State/UTs
Disruption
(Q2 of 2020 to
Q4 of 2019)
Early
restoration
(Q3 of 2020 to
Q4 of 2019)
Restoration
(Q4 of 2020 to
Q4 of 2019)
Large State
Andhra Pradesh114%107%129%
Assam119%107%95%
Bihar75%100%93%
Chhattisgarh102%101%98%
Gujarat106%100%100%
Haryana99%102%101%
Himachal Pradesh102%107%102%
Jharkhand97%106%115%
Karnataka94%93%105%
Kerala81%76%78%
Madhya Pradesh102%108%104%
Maharashtra98%93%98%
Odisha98%97%106%
Punjab98%101%104%
Rajasthan133%145%130%
Tamil Nadu112% 103%147%
Telangana99%82%91%
Uttar Pradesh55%90%92%
Uttarakhand119%123%123%
West Bengal91%102%97%
Small State
Arunachal Pradesh 112%125%92%
Goa78%82%80%
Manipur61%65%60%
Meghalaya106%136%115%
Mizoram117%122%130%
Nagaland127%148%135%
Sikkim128%123%116%
Tripura78%80%107%
Union
Teritorries
Andaman & Nicobar
Islands
150%118%221%
Chandigarh61%78%65%
Dadar Nagar Haveli &
Daman and Diu
79%67%86%
Delhi53%78%144%
Jammu & Kashmir147%156%158%
Lakshadweep91%97%102%
Puducherry99%119%108%
All India87%99%103%
Key
>= 100%
<100% and >= 75%
<75% and >= 50%
<75% and >= 25%
<25%
Figure 28: Disruption and restoration of number of pregnant women who received
180+ IFA tablets, HMIS Data, October 2019-December 2020
Source: HMIS publicly available data, Ministry of Health and Family Welfare
Delivering POSHAN Abhiyaan Interventions during a Pandemic: How are States doing?
73 Compared with the pre-pandemic period, the number of pregnant women who received
four or more ANC check-ups reduced in most States and UTs (30 out of 35 States/
UTs) (Figure 29). The largest decline was in Manipur, Nagaland, Delhi and Uttar Pradesh.
Positively, in June-September 2020, 26 States and UTs that had reported a decline in the
number of pregnant women attending ANC visits the previous quarter had improved.
Among these, Gujarat, Himachal Pradesh, Madhya Pradesh and Rajasthan recovered to the
pre-pandemic period. The situation further improved in October-December 2020 in many
States, and 13 States and UTs were covering more than pre-pandemic levels. However,
coverage remained low in Goa, Manipur, Nagaland, Chandigarh, Delhi and Jammu and
Kashmir. Ladakh was excluded because data were not available for all periods.
74
Delivering POSHAN Abhiyaan Interventions during a Pandemic: How are States doing? State/UTs
Disruption (Q2
of 2020 to Q4 of
2019)
Early restoration
(Q3 of 2020 to
Q4 of 2019)
Restoration (Q4
of 2020 to Q4 of
2019)
Large State
Andhra Pradesh112%111%135%
Assam62%80%90%
Bihar62%91%93%
Chhattisgarh92%98%97%
Gujarat97%101%104%
Haryana75%93%94%
Himachal Pradesh 85%104%102%
Jharkhand67%97%108%
Karnataka85%86%93%
Kerala93%89%97%
Madhya Pradesh88%108%107%
Maharashtra96%96%97%
Odisha95%98%107%
Punjab82%99%95%
Rajasthan83%107%107%
Tamil Nadu109%100%112%
Telangana80%82%90%
Uttar Pradesh54%86%97%
Uttarakhand87%96%102%
West Bengal65%92%98%
Small State
Arunachal Pradesh 71%88%95%
Goa75%75%72%
Manipur51%45%49%
Meghalaya70%99%98%
Mizoram80%96%107%
Nagaland52%60%67%
Sikkim92%93%94%
Tripura78%83%92%
Union
Teritorries
Andaman & Nicobar
Islands
103%115%122%
Chandigarh62%73%65%
Dadar Nagar Haveli
& Daman and Diu
73%75%82%
Delhi52%75%71%
Jammu & Kashmir57%57%62%
Lakshadweep103%94%111%
Puducherry113%141%167%
All India76%93%99%
Key
>= 100%
<100% and >= 75%
<75% and >= 50%
<75% and >= 25%
<25%
Figure 29: Disruption and restoration of number of pregnant women who received four or more
ANC visits, HMIS Data, October 2019-December 2020
Source: HMIS publicly available data, Ministry of Health and Family Welfare
Delivering POSHAN Abhiyaan Interventions during a Pandemic: How are States doing?
75 Key findings on changes in coverage of number of institutional deliveries
conducted, and number of women receiving 1
st
post-partum check-up between 48
hours and 14 days
The number of women who delivered in institutional facilities and received post-partum
check-ups declined post-December 2019 (Figure 30). This decline continued until
April 2020-June 2020, after which coverage of both services increased, yet remained
slightly below the pre-pandemic level. By October-December 2020, nearly 5,348,000
beneficiaries delivered in institutional facilities compared to the pre-pandemic levels
of 5,498,000. Approximately 3,052,000 beneficiaries received postpartum check-ups
between 48 hours – 14 days of birth, compared with the pre-pandemic levels of 3,131,000.
Figure 30: Changes in the number of institutional deliveries conducted and the
number of women receiving the first post-partum check-up between 48 hours and
14 days from October 2019 to December 2020
Source: HMIS publicly available data, Ministry of Health and Family Welfare
The number of institutional deliveries conducted (including C-section) reduced in most
States and UTs (32 out of 35 States/UTs) compared with the pre-pandemic period (Figure
31). The largest decline was in Bihar and Chandigarh. In June-September 2020, there was
an improvement 29 States and UTs, which experienced a reduction in previous quarter.
Among these, Himachal Pradesh, Madhya Pradesh, Rajasthan, Uttarakhand, Sikkim, and
Jammu and Kashmir were able to restore to the pre-pandemic level. Similarly, the situation
further improved in October-December 2020 in many States, and 10 States and UTs
were covering more than pre-pandemic levels. The coverage remained low in Manipur,
Chandigarh, Delhi, and Puducherry, whereas other States and UTs were covering more
than 75% of the pre-pandemic level. Data were unavailable for Ladakh for all periods;
thus, Ladakh was excluded from this analysis.
76
Delivering POSHAN Abhiyaan Interventions during a Pandemic: How are States doing? State/UTs
Disruption (Q2
of 2020 to Q4
of 2019)
Early
restoration (Q3
of 2020 to Q4
of 2019)
Restoration (Q4
of 2020 to Q4 of
2019)
Large State
Andhra Pradesh90%94%100%
Assam60%81%97%
Bihar49%84%92%
Chhattisgarh86%99%103%
Gujarat72%92%99%
Haryana69%95%96%
Himachal Pradesh 81%103%102%
Jharkhand79%99%105%
Karnataka90%94%100%
Kerala100%94%95%
Madhya Pradesh79%105%105%
Maharashtra89%95%102%
Odisha86%87%99%
Punjab63%94%95%
Rajasthan76%107%106%
Tamil Nadu92%92%99%
Telangana86%89%87%
Uttar Pradesh53%89%96%
Uttarakhand76%105%101%
West Benqal76%85%91%
Small State
Arunachal Pradesh 71%95%98%
Goa84%80%85%
Manipur68%65%68%
Meqhalaya74%91%94%
Mizoram72%81%96%
Nagaland54%62%77%
Sikkim96%113%120%
Tripura78%84%92%
Union
Teritorries
Andaman & Nicobar
Islands
106%117%123%
Chandigarh50%58%57%
Dadar Nagar Haveli
& Daman and Diu
58%68%79%
Delhi54%68%70%
Jammu & Kashmir 99%104%93%
Lakshadweep120%125%121%
Puducherry56%56%62%
All India72%92%97%
Key
>= 100%
<100% and >= 75%
<75% and >= 50%
<75% and >= 25%
<25%
Figure 31: Disruption and restoration of number of institutional deliveries conducted
(including C-section), HMIS Data October 2019- December 2020
Source: HMIS publicly available data, Ministry of Health and Family Welfare
Delivering POSHAN Abhiyaan Interventions during a Pandemic: How are States doing?
77 At the State-level, the number of women who received postpartum check-ups reduced
in 30 out of 34 States and UTs compared with the pre-pandemic period (Figure 32).
The maximum decline was in Bihar, Uttar Pradesh, Chandigarh, Delhi, and Lakshadweep.
During the early restoration period (June-September 2020), there was an improvement in
27 States and UTs where services were disrupted in previous period. States and UTs like
Himachal Pradesh, Jharkhand, Rajasthan, Uttarakhand, Meghalaya, Jammu and Kashmir,
and Lakshadweep were able to restore to the pre-pandemic level. During the fourth
quarter of 2020 (October-December 2020), coverage increased in 26 States and UTs
compared with the early restoration period, and coverage was higher than pre-pandemic
levels in 17 States and UTs. Coverage remained low in Kerala, Manipur, Andaman and
Nicobar Islands, and Delhi. Data were unavailable for Ladakh for all periods and Tamil
Nadu was an outlier; hence, they were excluded.
Key findings on changes in coverage of number of fully immunized children 9-11
months of age, number of newborns who received 6 HBNC visits, and number of
severely underweight children aged (0-5 years) provided health check-up
Health services to children including full-immunisation to children between 9-11 months
and six home-based newborn care (HBNC) visits after institutional delivery declined post-
December 2019, whereas providing health check-ups to severely underweight children
reduced only after March 2020 (Figure 33). In April-June 2020, full immunisation of
children reduced by 24%; HBNC visits reduced by 29%; and health check-ups of severely
underweight children reduced by 33% compared with the October-December 2019 pre-
pandemic period. Post-June 2020, the delivery of all three services to children improved
and exceeded the pre-pandemic levels for HBNC visits and health check-ups for severely
underweight children by December 2020. The provision of full immunisation dropped
post-September 2020, which resulted in slightly lower level by December 2020 compared
with pre-pandemic levels (6,247,000 vs 63,03,000). The reduction in rate of immunization
may have resulted due to hesitancy among caregivers to take care of children to healthcare
facilities due to fear of exposure to COVID-19 and further engagement and over burdening
of health care workers in COVID response had affected the coverage.
78
Delivering POSHAN Abhiyaan Interventions during a Pandemic: How are States doing? State/UTs
Disruption
(Q2 of 2020 to
Q4 of 2019)
Early
restoration
(Q3 of 2020 to
Q4 of 2019)
Restoration
(Q4 of 2020 to
Q4 of 2019)
Large State
Andhra Pradesh100%107%123%
Assam57%77%91%
Bihar43%78%91%
Chhattisgarh86%99%101%
Gujarat69%89%96%
Haryana69%96%98%
Himachal Pradesh82%102%103%
Jharkhand78%100%108%
Karnataka90%96%104%
Kerala77%73%69%
Madhya Pradesh106%140%143%
Maharashtra87%95%96%
Odisha91%92%102%
Punjab66%95%98%
Rajasthan74%117%114%
Telangana118%122%135%
Uttar Pradesh46%79%91%
Uttarakhand92%143%142%
West Bengal65%84%93%
Small State
Arunachal Pradesh 121%190%177%
Goa86%76%80%
Manipur58%58%51%
Meghalaya95%112%114%
Mizoram55%75%96%
Nagaland79%89%113%
Sikkim78%105%108%
Tripura86%95%114%
Andaman & Nicobar
Islands
52%74%62%
Union
Teritorries
Chandigarh39%85%86%
Dadar Nagar Haveli &
Daman and Diu
61%83%175%
Delhi40%46%54%
Jammu & Kashmir98%103%93%
Lakshadweep5%119%120%
Puducherry83%88%82%
All India70%89%97%
Key
>= 100%
<100% and >= 75%
<75% and >= 50%
<75% and >= 25%
<25%
Figure 32: Disruption and restoration of number of women who received postpartum
check-ups between 48 hours and 14 days, HMIS Data, October 2019-December 2020
Source: HMIS publicly available data, Ministry of Health and Family Welfare
Delivering POSHAN Abhiyaan Interventions during a Pandemic: How are States doing?
79 Figure 33: Changes in number of children who received fully immunized (9-11 months),
6 HBNC visits (newborns), and health check-up (severely underweighted children 0-5
years) from October 2019 to December 2020.
Source: HMIS publicly available data, Ministry of Health and Family Welfare
The number of children (9-11 months) who are fully immunized reduced in 28 out of 35
States and UTs, compared to the pre-pandemic period (Figure 34). Bihar, Jharkhand,
Uttar Pradesh, Sikkim and Delhi reported the largest decline. In June-September 2020,
there was an increase in fully immunized children in 27 States and UTs, where there
was a decline in previous period. However, the coverage declined slightly by the fourth
quarter (October -December 2020) in 23 States and UTs due to which the total number
of children fully vaccinated reduced by 1% at the national-level during the fourth quarter
of 2020. Data were not available for Ladakh for all periods; therefore, data on Ladakh
have been excluded.
80
Delivering POSHAN Abhiyaan Interventions during a Pandemic: How are States doing? State/UTs
Disruption (Q2
of 2020 to Q4
of 2019)
Early
restoration (Q3
of 2020 to Q4
of 2019)
Restoration (Q4
of 2020 to Q4 of
2019)
Large State
Andhra Pradesh109%114%104%
Assam76%94%100%
Bihar64%100%100%
Chhattisgarh87%100%99%
Gujarat92%110%103%
Haryana89%103%99%
Himachal Pradesh 106%110%101%
Jharkhand70%103%104%
Karnataka90%105%107%
Kerala102%93%98%
Madhya Pradesh91%110%101%
Maharashtra84%99%102%
Odisha99%108%116%
Punjab104%110%102%
Rajasthan83%100%87%
Tamil Nadu98%101%93%
Telangana98%138%96%
Uttar Pradesh48%86%97%
Uttarakhand95%103%109%
West Bengal78%113%98%
Small State
Arunachal Pradesh 94%102%96%
Goa95%100%92%
Manipur76%82%92%
Meghalaya98%115%101%
Mizoram94%104%100%
Nagaland76%108%103%
Sikkim68%57%67%
Tripura77%93%100%
Union
Teritorries
Andaman & Nicobar
Islands
108%106%101%
Chandigarh83%102%87%
Dadar Nagar Haveli
& Daman and Diu
82%103%94%
Delhi54%97%83%
Jammu & Kashmir86%95%99%
Lakshadweep113%129%104%
Puducherry121%118%94%
All India76%100%99%
Key
>= 100%
<100% and >= 75%
<75% and >= 50%
<75% and >= 25%
<25%
Figure 34: Disruption and restoration of number of children (9-11 months) fully
immunised, HMIS Data, October 2019-December 2020
Source: HMIS publicly available data, Ministry of Health and Family Welfare
Delivering POSHAN Abhiyaan Interventions during a Pandemic: How are States doing?
81 At the State-level, the number of newborns who received HBNC visits reduced in most
States and UTs (27 out of 34 States/UTs) compared with the pre-pandemic period of
October-December 2019 (Figure 35). Bihar, Uttar Pradesh and Delhi reported the largest
decline in this indicator. During the early restoration period (June-September 2020), 24
States and UTs where HBNC visits were disrupted had since improved the coverage.
Encouragingly, Jharkhand, Kerala, Madhya Pradesh, Maharashtra, Rajasthan, Arunachal
Pradesh, Meghalaya and Chandigarh restored coverage to pre-pandemic levels by June-
September 2020. Similarly, HBNC visits further increased in 28 States and UTs due to
which the coverage surpassed the pre-pandemic levels at the national level in fourth
quarter of 2020. While the coverage remained low in Goa, and Delhi. Data were not
available for Dadar and Nagar Haveli and Daman and Diu for all periods and Tamil Nadu
was an outlier, hence these large states were excluded.
The number of severely underweight children who received health check-up were
disrupted in 25 out of 34 States and UTs, compared to pre-pandemic period. However, the
provision of the service improved substantially in June-September 2020 in 22 States and
UTs, where there were disruptions earlier. Consequently, the services were able to restore
to the pre-pandemic period in the third quarter of 2020. There was a slight decrease
in health check-ups in October-December 2020, yet the coverage remained above pre-
pandemic levels. States and UTs like Himachal Pradesh, Mizoram, Delhi, Sikkim, Tripura,
and Uttarakhand had the least coverage in quarter four of 2020 (October- December
2020), compared to the pre-pandemic period. Data were not available for Ladakh for
all periods and Tamil Nadu was an outlier; hence; these States have been excluded from
this analysis.
82
Delivering POSHAN Abhiyaan Interventions during a Pandemic: How are States doing? State/UTs
Disruption
(Q2 of 2020 to
Q4 of 2019)
Early
restoration
(Q3 of 2020 to
Q4 of 2019)
Restoration
(Q4 of 2020 to
Q4 of 2019)
Large State
Andhra Pradesh110%113%139%
Assam69%73%98%
Bihar49%84%95%
Chhattisgarh84%98%103%
Gujarat75%95%104%
Haryana77%87%122%
Himachal Pradesh 83%94%108%
Jharkhand81%109%116%
Karnataka124%120%135%
Kerala89%116%88%
Madhya Pradesh92%132%148%
Maharashtra85%100%113%
Odisha92%98%105%
Punjab70%85%98%
Rajasthan81%110%111%
Telangana90%96%117%
Uttar Pradesh49%91%113%
Uttarakhand78%96%127%
West Bengal61%85%101%
Small State
Arunachal Pradesh 92%121%139%
Goa174%16%11%
Manipur64%69%83%
Meghalaya96%123%133%
Mizoram121%124%146%
Nagaland71%90%102%
Sikkim97%92%110%
Tripura80%90%111%
Union
Teritorries
Andaman & Nicobar
Islands
138%219%225%
Chandigarh87%114%101%
Dadar Nagar Haveli
& Daman and Diu
92%90%106%
Delhi24%29%55%
Jammu & Kashmir91%98%94%
Lakshadweep106%133%106%
Puducherry105%109%126%
All India71%95%111%
Key
>= 100%
<100% and >= 75%
<75% and >= 50%
<75% and >= 25%
<25%
Figure 35: Disruption and restoration of number of newborns who received 6 HBNC visits after
institutional delivery, HMIS Data October 2019-December 2020
Source: HMIS publicly available data, Ministry of Health and Family Welfare
Delivering POSHAN Abhiyaan Interventions during a Pandemic: How are States doing?
83 State/UTs
Disruption
(Q2 of 2020 to
Q4 of 2019)
Early
restoration
(Q3 of 2020 to
Q4 of 2019)
Restoration
(Q4 of 2020 to
Q4 of 2019)
Large State
Andhra Pradesh134%284%202%
Assam45%97%69%
Bihar129%223%177%
Chhattisgarh62%188%106%
Gujarat48%104%57%
Haryana149%139%211%
Himachal Pradesh14%18%8%
Jharkhand33%99%139%
Karnataka55%164%84%
Kerala120%148%127%
Madhya Pradesh107%183%211%
Maharashtra63%81%85%
Odisha72%82%77%
Punjab85%130%98%
Rajasthan45%85%112%
Telangana194%182%456%
Uttar Pradesh27%69%81%
Uttarakhand21%46%49%
West Bengal30%38%62%
Small State
Arunachal Pradesh2%2%189%
Goa2%15%85%
Manipur200%80%620%
Meghalaya54%104%76%
Mizoram71%3%23%
Nagaland10%35%126%
Sikkim471%17%48%
Tripura30%52%40%
Andaman & Nicobar
Islands
22%50%58%
Union
Teritorries
Chandigarh59%37%51%
Dadar Nagar Haveli &
Daman and Diu
64%89%296%
Delhi33%39%23%
Jammu & Kashmir57%76%99%
Lakshadweep250%250%150%
Puducherry44%405%74%
All India67%112%110%
Key
>= 100%
<100% and >= 75%
<75% and >= 50%
<75% and >= 25%
<25%
Figure 36: Disruption and restoration of number of severely underweighted children (0-5 years)
who received health check-ups, HMIS Data, October 2019- December 2020
Source: HMIS publicly available data, Ministry of Health and Family Welfare
84
Delivering POSHAN Abhiyaan Interventions during a Pandemic: How are States doing? Overall, services like pregnant women who received 180+ IFA and children (9-11 months)
fully immunized experienced least disruption compared to other services. While, severely
underweighted children who received health check-up declined significantly in April-
June 2020. Encouragingly, the coverage of IFA to pregnant women, HBNC visits, and
health check-up for severely underweight children were restored and exceeded the pre-
pandemic coverage. Other services including four or more ANC, institutional delivery,
post-partum check-ups, and child immunisation were unable to reach the pre-pandemic
level, but it is noteworthy that their coverage was more than 95% of the pre-pandemic
period. However, despite restorations, the pre-pandemic levels of coverage of these health
services in many states were sub-optimal, and NFHS-5 reveals several coverage gaps.
5.2.3 State innovations in delivering health services (core POSHAN
Abhiyaan interventions)
States adopted different strategies to continue service delivery during COVID-19, which
varied by geography and by the type of service. Out of the 34 states for which state data
was received, 26 states/UTs reported making some innovations to ensure the delivery of
health interventions to the beneficiaries during the COVID-19 pandemic. The table below
summarises the state-wise innovation, by services.
Table 7: Summary of health programme delivery innovations in the context of
COVID-19, as reported by State Governments
State/UTs
Innovations for
distribution
of IFA (syrup,
pink, red, blue)
Innovations
for
distribution
of ORS and
zinc
Innovations for
immunisation
Innovations for
counselling
Andaman
& Nicobar
Islands
Mobilization of
beneficiaries
Andhra
Pradesh
During IDCF
2020
Token based system
to prevent crowd
Arunachal
Pradesh
Tracking system to
monitor status
Virtual counselling,
distribution of
material
Assam
Home
distribution
During IDCF
2020
During VHNDs
Use of mobile
phones
Bihar
Home
distribution
Chandigarh By FLWs
During IDCF
2020
Chhattisgarh
Home
distribution
Home
distribution
Mobilization of
beneficiaries
DNH & DD
Delhi
Home
distribution
Home
distribution
Home visits
Delivering POSHAN Abhiyaan Interventions during a Pandemic: How are States doing?
85 State/UTs
Innovations for
distribution
of IFA (syrup,
pink, red, blue)
Innovations
for
distribution
of ORS and
zinc
Innovations for
immunisation
Innovations for
counselling
Goa
Gujarat
Home
distribution
During IDCF
2020 & home
distribution
Haryana
Home
distribution
During IDCF
2020
Home visits
Himachal
Pradesh
Home
distribution
During IDCF
2020
Virtual trainings
to handle vaccine
among COVID-19
Jammu &
Kashmir
Home
distribution &
during VHNDs
Mobilization of
beneficiaries
Mobile
applications and
home visits
Jharkhand
Community
based, virtual
trainings for
FLWs
Community
based
Wall writing Virtual counselling
Karnataka
Virtual training
sessions conducted.
Outreach sessions
organized
Kerala
At AWC for
out-of-school
Decentralized
ORS depots
Pre-book
appointments to
prevent crowd
Tele-counselling
through toll-free
number
Ladakh
Home
distribution
Home
distribution
Mobilization of
beneficiaries
Lakshadweep
Madhya
Pradesh
Home
distribution &
tele-monitoring
to ensure
availability
Virtual training
sessions conducted.
In-person small
groups
Maharashtra
Home
distribution
Home
distribution
Manipur
Mental health
counselling to
inmates of jails
and old age
homes
Meghalaya
MizoramIncomplete template received
Nagaland
Home
distribution
Odisha
During IDCF
2020
86
Delivering POSHAN Abhiyaan Interventions during a Pandemic: How are States doing? State/UTs
Innovations for
distribution
of IFA (syrup,
pink, red, blue)
Innovations
for
distribution
of ORS and
zinc
Innovations for
immunisation
Innovations for
counselling
Puducherry
Community
based
By FLWs
Mobilization of
beneficiaries
Punjab
Home
distribution
Conducted
maintaining
COVID-19 protocol
Through mobile
phones & home
visits
Rajasthan
Sikkim
Home
distribution
Home
distribution
Conducted
maintaining
COVID-19 protocol
Through mobile
phones & home
visits
Tamil Nadu
Telangana
Tripura
Uttar Pradesh
IFA distribution
combined with
Vitamin A
Uttarakhand
West BengalTemplate not received
Source: Reported by states in response to questionnaires sent by NITI Aayog in Sept 2020
Note: IDCF-Intensified Diarrhoea Control Fortnight
Distribution of IFA (syrup, pink, red, blue)
Several states opted for home distribution of IFA. Few states delivered IFA during
community-based events, VHSNDs and through FLWs. Kerala provided IFA at AWCs
for out-of-school children. Madhya Pradesh ensured the availability of IFA through tele-
monitoring. In Uttar Pradesh, the distribution of IFA syrup was combined with bi-annual
Vitamin A supplementation to ensure distribution to all beneficiaries and for reporting
purposes.
Distribution of ORS and zinc
Seven states ensured the implementation of Intensified Diarrhoea Control Fortnight 2020
for children under-five years of age. In a few states, ORS and zinc were distributed at
beneficiaries’ homes or at the community-level. Kerala decentralized the ORS depots from
AWC to the level of one household for every 10 houses in a community.
Immunization
Several adaptations were made by States to provide immunisation to beneficiaries
ranging from identifying alternate sites for immunisation, following a staggered approach,
maintaining COVID-19 protocol, providing information and guidance to FLWs to conduct
immunisations using technology.
Delivering POSHAN Abhiyaan Interventions during a Pandemic: How are States doing?
87 Counselling
States used different approaches to reach beneficiaries to ensure the most vulnerable
population received the services and most of the beneficiaries were covered. Use of
mobile phones, virtual and tele counselling and home visits were some of the adaptations
made to ensure that counselling services reach the beneficiaries.
5.3 MULTI-SECTORAL INVOLVEMENT AND POLICY ACTION
DURING COVID-19
Multiple ministries have been contributing in POSHAN Abhiyaan to address malnutrition
through tackling its many determinants, and have taken concerted efforts to continue
their regular activities to ensure that POSHAN Abhiyaan is being implemented despite
the COVID-19-related disruptions. Similarly, development partners have also shifted their
focus in undertaking initiatives for successful implementation of POSHAN Abhiyaan
during the pandemic. This section summarises the measures taken by key Ministries and
development partners in 2020.
5.3.1  Ministry of Women and Child Development
Best practices, during COVID-19 at the central-level
In the form of Advisories and other formal communications the MoWCD ensured the
continuum of care to the beneficiaries even during the challenging COVID-19 times. For
example, a letter (on 11 March 2020) was issued to all States/UTs in the view of the
COVID-19 outbreak, which indicated that the AWWs and Supervisors should be utilized
in surveillance and other community-level activities conducted by MoHFW, mobilization
of the self-help groups (SHGs) to create awareness, and proper sanitation and health
education to children and their parents. Furthermore, AWWs and helpers were also
actively involved in conducting other activities during COVID-19, such as door-to-door
surveys, community surveillance, etc. Another formal communication in the form of a DO
letter on (19 May 2020) was issued to all States/UTs, which indicated that distribution of
food items and nutrition support would be conducted by AWWs once every 15 days for
beneficiaries (children, pregnant women and lactating mothers) to ensure continuity of
the supplementary nutrition programme.
In view of COVID-19 context, the life cover for AWWs/Anganwadi helpers who are 51-59
years of age was increased from ₹ 30,000/- to 2,00,000/- for a period of three months—
that is, up to 30 June 2020.
Additionally, many State-level initiatives were initiated amid COVID-19. One example
recognized by MWCD is establishing nutri-gardens in Lakshadweep. In collaboration
with the Departments of Women and Child Development, Agriculture Rural Development
and Village Panchayats, Lakshadweep promoted Anganwadi Kitchen Gardens and Nutri-
Gardens for a continuous supply of green leafy vegetables and fruits during COVID-19
outbreak.
88
Delivering POSHAN Abhiyaan Interventions during a Pandemic: How are States doing? 5.3.2  Ministry of Health and Family Welfare
Best practices, especially during COVID-19 times
Continued support was provided to States and UTs through regular video conferences
(VC) and webinars on the implementation of various interventions amid COVID-19,
including AMB, newborn care provision in the special newborn care units (SNCUs),
continuation of breastfeeding and promotion of IYCF practices, implementation of NDD
and diarrhoea control and prevention activities, facility-based management of sick SAM
children in NRCs. Guidance notes for undertaking various activities were prepared, and
intensive awareness generation activities through social media, mid and mass media were
also carried out.
5.3.3  Ministry of Drinking Water and Sanitation
Best Practices, especially during COVID-19 times
Empowering migrant labourers through Garib Kalyan Rojgar Abhiyaan, Bihar
A total of 24 labourers were engaged in the construction of a community sanitary complex
at Ward No. 8 of Tulapatti Gram Panchayat in Kishanpur Block of Supaul District in Bihar.
The move was not only a step towards ensuring better community sanitation practices
but also an assurance of employment to many migrants who had to return to Bihar due
to COVID-19 outbreak. These migrants were provided with work under the Garib Kalyan
Rojgar Abhiyaan.
5.3.4 Initiatives taken by Development Partners during COVID-19
Pandemic
Strengthening the delivery of nutrition benefits and services in the context
of COVID-19:
State-level government bodies in the States of Jharkhand, Madhya Pradesh, Gujarat,
Uttar Pradesh, and Rajasthan developed a joint recommendation note and supported
implementation to strengthen the delivery of nutrition services in the context of COVID-19.
Organizations like Alive and Thrive (A&T) in collaboration with WeCan has been actively
participating in addressing nutrition-related issues, especially during the COVID-19
pandemic. A&T also collaborated with key development partners namely UNICEF, WHO,
World Bank, National Centre of Excellence and Advance Research on Diets, and Ministry
of Health and Family Welfare for providing technical inputs in the design and development
of social behaviour change communications for MIYCN during COVID-19.
In Bihar, A&T coordinated with State Health Society Bihar and remotely assessed the
coverage of ASHA’s home visits and IYCF counselling including tele-counselling activities
during the national lockdown in April 2020. The assessment was based on telephonic
interviews by ASHA facilitators using a standard checklist, which was later analysed by
A&T. Similarly, A&T conducted telephonic interviews with frontline workers, pregnant
women, and women with children below 2 years in Uttar Pradesh for examining the
Delivering POSHAN Abhiyaan Interventions during a Pandemic: How are States doing?
89 effects of COVID-19 on provision and use of health and nutrition services during and
after lockdown.
Promoting community involvement for improving health and nutrition related
outcomes in Aspirational Districts during COVID-19 times
The onset of COVID-19 and subsequent lockdowns have resulted in a halt in many health
and nutrition activities for children as the AWCs were closed. This severely impacted
the feeding practices and initiation of complementary feeding, due to which the District
administration along with Piramal Foundation decided to organize events such as
Annaprasan Divas and Godbharai Divas at the houses of the beneficiary itself to avoid
gatherings of beneficiaries. The initiative was introduced in the Aspirational District of
Sitamarhi, Bihar. After devising the guidelines and protocols to be followed, the AWWs
were motivated to visit the beneficiaries houses for ensuring that nutrition and health are
receiving adequate attention. Soon, the AWWs started home-based Annaprasan Divas for
children who completed six months. At the event, the family prepares soft semi-solid food
for the child to mark the celebration of Annaprasan Divas, and the AWW further counsel
beneficiaries regarding the benefits of breastfeeding and complementary feeding. With
the continued efforts of the FLWs, Block Transformation Officers (BTO), and District
officials, the AWWs have been able to successfully organize Annaprasan Divas in 275
households, and Godbharai Divas in 210 households.
District Administration intervened by setting up ‘Nutri Gardens’ at CHC and AWC with
Piramal Foundation where the beneficiaries had access to some fruits and vegetables
grown in the garden and were taught about the nutritional value of different fruits and
vegetables, and finally encouraged to adopt practicing kitchen gardens within their
households. Additionally, the project is a self-sustaining project which ensures access to
healthy fruits and vegetables in an affordable way as most inputs are available locally, and
villagers do not require any additional skills for setting up the ‘Nutri Garden’ due to their
existing engagement in farming. So far, five Anganwadi sites in the Aspirational District
Chitrakoot, Uttar Pradesh have been developed functional gardens where beneficiaries
visit regularly. Over 300 pregnant women and 280 lactating mothers have visited the
gardens and have been counselled on improving their dietary intakes.
In Sonbhadra, Uttar Pradesh the DM District Administration along with the technical
support of the Piramal Foundation undertook the decision utilizing the District Mineral
Funds for purchasing growth monitoring tools for the AWC. In total, 95 lakh were used
to purchase 8,500 growth monitoring tools, including stadiometers, infantometers, baby
weighing machines, adult weighing machines, and MUAC tapes. After procurement, a
series of trainings were conducted to ensure the efficient usage of the tools. Throughout
the process, capacity building of 72 ICDS supervisors and CDPO on the use of growth
monitoring tools were conducted, and 1653 AWWs were installed with growth monitoring
equipment. There has been a significant increase in the growth monitoring of the children,
and even during the COVID-19 pandemic, 1,45,140 children were monitored. Additionally,
children who were identified as severely acutely malnourished were referred to the
Nutritional Rehabilitation Centres for recovery. Finally, the strategy detects early growth
retardation so that appropriate steps can be taken for the same.
90
Delivering POSHAN Abhiyaan Interventions during a Pandemic: How are States doing? Field-level relief measures during the COVID-19 pandemic
The centralised kitchens programme in Nashik and Palghar, which is run in collaboration
with the Tribal Development Department, Government of Maharashtra and TATA trusts, has
expanded its services to provide meals to migrant workers amid the COVID-19 pandemic.
Since 3 April 2020, the kitchen in Palghar has been providing hot meals and dry rations
to stranded migrants in the shelter camps in Tawa and Talasari blocks. More than 67,000
meals have been served, where around 5,000 people are being served cooked meals
each day, and over 400 kilograms worth of dry ration that includes flour, pulses, oil, and
spices has been distributed. Similarly, in Nashik, 2,800 dry ration kits were distributed
in a week’s time to approximately 2,800 families with the collaborative efforts of Trusts,
BAIF and Tata AIG volunteers.
Similarly, to address the challenges in the availability of food and nutrition amid the
COVID-19 pandemic, relief initiatives for the vulnerable communities across India were
undertaken. Under the relief operation, the Tata Trusts combined forces with the associate
organisation The India Nutrition Initiative (TINI) to distribute packets of GoMo, a healthy
legume-based ready-to-eat snack. As yellow pea is the main ingredient, the snack is
rich in protein and fiber, and has been fortified with micronutrients. The packets were
distributed across critical pockets, such as slums, construction sites, cancer treatment
hospitals, migrant settlements, primitive tribal hamlets in remote parts of the country, etc.
Besides, the snack was also distributed to the country’s frontline workers namely police
personnel, healthcare workers, etc. Around 44 non-governmental organization (NGO)
partners freely distributed around 1.7 million GoMo packets across 700,000 households in
over 30 Districts in nine States- Maharashtra, Uttar Pradesh, Andhra Pradesh, Telangana,
Delhi, Gujarat, Rajasthan, Haryana, and Tamil Nadu.
Capacity building of frontline workers in COVID-19 pandemic
To bring the visibility through the month-long celebration of POSHAN Maah, the network
of Centres of Excellence for SAM comprising of the National Centre of Excellence (NCoE-
SAM) and State Centre of Excellences for management of SAM (SCoE-SAM) under the
Government leadership and guidance from UNICEF, joined hands to accelerate SAM
management-related activities during September 2020.
NCoE-SAM and SCoE-SAM conducted various training programmes in many States to
build capacity for identifying children with SAM, adhering to the infection prevention
and control from the COVID-19 pandemic protocol. In Bihar, SCoE along with Piramal
Foundation conducted training on identification and referral of SAM in 5 Aspirational
Districts. On the other hand, in Chhattisgarh SCoE, All India Medical Institute of Science
(AIIMS), Raipur conducted telephonic follow-ups of the discharged children from NRCs
and counselled the parents regarding the identification of danger signs in children, home-
based nutrition and care, and signs and symptoms of COVID-19 and preventive measures.
In Jharkhand, a four-day State-level training was conducted to build the capacity and
orient the medical college faculties and students, District officials of West Singhbhumand
and development partners on the comprehensive community-based management of
children with SAM programme. Similarly, online trainings and orientations were conducted
for frontline workers under ICDS in Odisha and Rajasthan.
Delivering POSHAN Abhiyaan Interventions during a Pandemic: How are States doing?
91 Technical Support: CoE has also provided technical support in the preparation of guidelines
and training modules in Rajasthan for their project AMMA, and support was also provided
to ICDS Department of Bihar for developing a comprehensive guidance note on activities
regarding early screening of SAM at a community and facility level under the Health
Department. Additionally, an expert consultation was held with the district administration
of West Singhbhum for implementation of the CMAM programme in the district adhering
to the infection prevention and control from COVID-19 protocols.
5.4  CONCLUSION AND WAY FORWARD
This chapter examined the impact of the pandemic on service disruptions and documented
various ways in which services are beginning to be restored across sectors in India.
The findings on service disruptions, drawing primarily on publicly available administrative
data highlight substantial disruptions in the early part of the pandemic, with restorations
beginning to be apparent in the middle of 2020.
The findings on early restorations and adaptations to service delivery are promising and
highlight a positive commitment across all levels – policy, implementation and frontline- to
attempt to restore essential services in health, nutrition and social safety nets. A range of
adaptations to service delivery are seen across specific platforms and interventions, and
these bode well for supporting the path to full restoration. At the same time, available
findings on the broader economic impacts of the pandemic highlight that poor families
are likely to need a wide range of social protection and economic support for improving
food security and care for pregnant and lactating women and young children in the
critical 1000-day window.
What implications do these findings have for India’s progress on improving nutrition?
ÂFirst, millions of babies born in 2020 have likely missed several essential
interventions in health and nutrition; therefore, the rapid and full restoration
of services is critical to the basic mission goal of delivering essential evidence-
based interventions. Efforts to increase household demand for services will also
be central to achieving coverage. To this end, demand creation to access and use
health and ICDS services should be a key focus of the SBCC pillar of POSHAN
Abhiyaan in 2021.
ÂSecond, the insight on economic and food distress suggests that social protection
measures must be strengthened and will need to reach families in the 1,000-day
period. Improving nutrition is challenging when families are in economic distress.
Nutrition-sensitive social protection could play a key role in helping families
provide better nutrition for their children.
ÂThird, addressing the fall-out of the impact on the education sector on adolescent
girls will be critical. Evidence has accumulated that education is critical to prevent
early marriage, which in turn is critical to prevent early childbearing in India. The
risks of increasing early marriage in the context of the pandemic are higher,
but little is known about the extent of the challenge. Community engagement
92
Delivering POSHAN Abhiyaan Interventions during a Pandemic: How are States doing? to ensure adolescent girls can return to school and that early marriages are
prevented will, therefore, also need sharp focus in 2021. Additionally, RKSK may
mobilize community to prevent early marriage of adolescent girls with the help
of FLWs.
ÂFourth, it is recommended that for providing convergence of WCD and Health
services to fight undernutrition, the provision of seamless data sharing between
ICDS-CAS/POSHAN Tracker and RCH should be developed. Additionally,
conducting joint convergent trainings/activities with the field level staff on
how to constantly share data and information is necessary for successful inter-
sectoral convergence.
ÂFifth, all available services – whether special services in the context of the
pandemic or routine services – should be reaching families in the first 1000
days in a timely and targeted manner. At this time, little is known about how to
achieve effective household convergence, but the evidence is strong that this is
currently poor and therefore, must be a key goal for the efforts to strengthen
the convergence pillar of POSHAN Abhiyaan.
Delivering POSHAN Abhiyaan Interventions during a Pandemic: How are States doing?
93 Conclusions and
Recommendations6
This progress report has assessed the implementation of POSHAN Abhiyaan; analysed
the impact of the COVID-19 pandemic on nutrition and health services and generated
and curated insights on service delivery restorations and adaptations and other related
needs across India.
First, on a positive note, the assessment of system readiness and capabilities to deliver
POSHAN Abhiyaan interventions demonstrate improvements from the previous POSHAN
Abhiyaan progress reports. Despite the improvement, challenges pertaining to low fund
utilization, insufficient human resources, and gaps in training and capacity building of
the staff. Additionally, the coverage of the service delivery has a mixed performance
where many indicators have acceptable coverage, but few indicators are lagging behind.
Together, these signal that although progress is along expected lines, but given the
complex systems preparedness, focus on accelerating coverage of key interventions is
required.
Key recommendations
ÂClose all implementation system-related gaps in delivery of POSHAN Abhiyaan’s
core components. These include accelerating the use of funds released for
POSHAN Abhiyaan, ensuring adequate number of health facilities and supplies,
ensuring that technology integration continues, and ensuring that capacity
building of workers is focused both on coverage and quality.
ÂMaximise convergence-related efforts in the coming years, targeting and focusing
all efforts to achieve household convergence of key programs, especially those
addressing the determinants that have been slow to move or negatively affected
in 2020.
ÂCreate an enabling environment for seamless data sharing between ICDS-CAS/
POSHAN Tracker and reproductive and child health (RCH) services to facilitate
convergence between WCD and health services. Additionally, conducting joint
convergent trainings/activities with field-level staff on how to constantly share
data and information is also necessary.
95
ÂWith the introduction of POSHAN Tracker, it can be utilised to monitor the
supply and delivery of THR. The tracker must be integrated with the RCH portal
to identify prevalence of malnutrition. All visits of AWWs should be tracked and
best 100 AWWs per month in every state may be incentivized and their photos/
mobile numbers may be displayed on POSHAN tracker.
Second, the analysis of service disruptions, drawing primarily on administrative data
highlights substantial disruptions in the early part of the pandemic. Although restorations
are apparent beginning in the middle of 2020, the restorations in June 2020 (the last
month for which data are available in public domain) indicate that full restoration to
December 2019 levels are still not apparent for various services. However, in several
states, it appears that higher reach of food supplements was achieved in the immediate
post-lockdown period, and this may have important lessons.
Key recommendations
ÂGiven the importance of achieving full-scale coverage of the POSHAN Abhiyaan
core interventions, efforts to restore service delivery are imperative, not just
to achieve pre-pandemic levels but to go beyond and achieve even greater
coverage and quality.
ÂServices that will need particular attention in the restoration of services will be
screening and monitoring of growth of all children, active support to EBF and
even greater efforts to support complementary feeding.
ÂEfforts to increase household demand for services are also going to be central
to achieving coverage; therefore, demand creation to access and use health
and ICDS services should likely be a key focus of the SBCC pillar of POSHAN
Abhiyaan in 2021.
Third, the findings on early restorations and adaptations to service delivery highlight a
positive commitment across all levels–policy, implementation and frontline–to attempt to
restore essential services in health, nutrition and social safety nets. A range of adaptations
to service delivery across specific platforms and interventions bode well for supporting
the path to full restoration. At the same time, available findings also highlight the broader
economic impacts of the pandemic on incomes and food security, even as recently as
October 2020. Addressing the fallout of the impact on the education sector on adolescent
girls will also be critical. Evidence has accumulated that education is critical to prevent
early marriage, which in turn is critical to prevent early childbearing in India. The risks of
increasing early marriage in the context of the pandemic are higher, but little is known
about the extent of the challenge.
Key recommendations
ÂThe efforts for convergence with key sectors, especially food and civil supplies
(PDS) and rural development (NREGA) will be essential for strengthening social
protection to vulnerable families. This will also ensure that the social protection
programmes reach families in the first 1,000 days of life. Furthermore, by
96
Conclusions and Recommendations incorporating nutri-cereals, fortified rice, and other nutritious foods into social
safety nets will help to make these provisions nutrition sensitive.
ÂEfforts to strengthen social protection to be more nutrition-sensitive and to
ensure that major social protection programmes reach families in the first 1000
days using the convergence action planning mechanisms will be essential.
ÂCommunity engagement to ensure adolescent girls can return to school and
that early marriages are prevented will also warrant urgent attention in 2021.
Despite significant progress on strengthening systems to support the delivery of key
POSHAN Abhiyaan interventions in the Health and WCD sectors, more work is needed
to close persisting gaps. In addition, the impacts of the COVID-19 pandemic mean that
millions of babies born in 2020 have likely missed several essential interventions in
health and nutrition. At the same time, there is also evidence of a broad system-wide
commitment to nutrition in the range of efforts to restore health and nutrition services
– across Ministries, States and development partners. The rapid and full restoration of
services is critical to the core POSHAN Abhiyaan goal of delivering essential evidence-
based interventions to all women and children.
In closing, this report offers sobering insights on the current state of malnutrition in India,
as well as several areas for optimism on the nutritional improvements underway in India.
With continued political leadership, system-wide implementation commitment, society-
wide support and focused action, India can eliminate malnutrition in all forms.
In 2021, an estimated 20 million babies will be born in India
6
. By investing more deeply
in solving the nutrition challenge, we have the power to assure the birth cohort of 2021
tremendous opportunities to strengthen their potential as future citizens. There is no
time to lose.
6 UNICEF Press Release, 7 May 2020
Conclusions and Recommendations
97 98 Key Takeaways
from POSHAN
Abhiyaan7
On 8 March 2018, the Honourable Prime Minister launched the POSHAN (Prime Minister’s
Overarching Scheme for Holistic Nutrition) Abhiyaan, which brought malnutrition to the
centre stage. Malnutrition, particularly in early life (especially during the first 1,000 days)
leaves an undeniable mark on child growth and development and can have irreversible
consequences. Globally, the success of nutrition programmes has been predicated on a
strong commitment on the part of the political and bureaucratic leadership. POSHAN
Abhiyaan, with political commitment from the highest level, created a conducive
environment to improve nutrition, with particular attention on the first 1,000-day window
of opportunity.
NITI Aayog has been involved in the conceptualization and monitoring of POSHAN
Abhiyaan, since its inception. The launch of POSHAN Abhiyaan brought together 18
ministries to synchronize their efforts for addressing direct and underlying determinants
of malnutrition. The POSHAN Abhiyaan adopted a multi-pronged approach to target
malnutrition. POSHAN Abhiyaan simultaneously also created an enabling environment
through its key pillars– convergence, information and communication technology (ICT),
monitoring, and Jan Andolan– to ensure coverage of high quality services through the first
two years of a child’s life. Since its inception, the POSHAN Abhiyaan has created mass
awareness and generated a spirited environment wherein all actors in the government
and society are engaged to overcome malnutrition.
The experience of implementing the POSHAN Abhiyaan over the past three years has
highlighted the following key lessons that must be carried forward to continue our efforts
for reducing malnutrition:
LESSON 1: POSHAN ABHIYAAN HAS HELPED TO BRING A STRONG
FOCUS ON IMPROVING NUTRITION OUTCOMES DURING THE FIRST
1,000 DAYS.
The first 1,000 days—the time approximately from conception to the second birthday of
the child, constitute the foundation period for optimal child health, growth and neural
99 development. The sensitive periods of brain development are susceptible to specific
nutritional deficiencies that could have long-term deficits. This is the period when children
require food with optimal nutrients, hygienic, nurturing and stimulating environments
along with optimal health care. Poor nutrition during this critical phase has consequences
throughout the lifecycle leading to delays in development, low earnings in adulthood,
and increased risk for chronic diseases as well as negatively influence next generations.
POSHAN Abhiyaan shifted the focus of nutrition programmes from merely distributing
food supplements to actively engaging all other stakeholders both on demand and
supply side. With the clear focus on improving the coverage of key health and nutrition
interventions, POSHAN Abhiyaan has contributed to laying a clear focus on:
ÂIncentivizing Early Registration and Complete Antenatal Care
ÂPromoting Institutional Deliveries
ÂAnaemia Prevention and management
ÂHealthy diets during pregnancy
ÂEarly and Exclusive Breastfeeding
ÂIntroducing Timely and Age appropriate Complementary Feeding, including a
focus on the quality of take home rations in the ICDS
ÂPromoting Dietary Diversity
ÂHome visits to New-born and young child Care
ÂKangaroo Mother Care and Optimal Feeding of low birth weight and small babies
ÂIntroduction of Rota virus vaccine and zinc supplementation along with ORS to
achieve zero diarrhoeal deaths
ÂIntroduction of Pnemono-coccal vaccine (in selected states) for upper respiratory
tract infections
ÂGrowth monitoring for early identification and management of MAM/SAM
children in the community
The assessments of system readiness and capabilities to deliver POSHAN Abhiyaan
interventions demonstrated improvements and there is an overall positive trend in the
coverage of interventions in most states. Taken together, these signal that progress is along
expected lines given the complex systems preparedness and the focus on accelerating
coverage of key interventions in the period between 2018 and 2020.
Gaps remain in service delivery and coverage. Geographically targeted diagnostic
analyses and related action are critical to close existing gaps in the reach of health and
ICDS interventions in the first 1000 days. In addition, ensuring strong linkages between
counselling and growth monitoring and distribution of take-home rations in ICDS and
ensuring that they reach all the households with a child below two years is critical.
Improving the composition and quality of the food supplements and increasing the reach
of the take-home rations is essential. The achievement of optimal infant and young child
feeding practices, particularly in ensuring appropriate complementary feeding practices,
100
Key Takeaways from POSHAN Abhiyaan remains a challenge. Therefore, it is imperative to use all existing programme platforms to
emphasize complementary feeding at every possibly contact with families with children
under two years of age.
The need of the hour is to sustain the POSHAN Abhiyaan for which actions looking
forward must now fully consider gaps in service delivery, convergence between ICDS
and health services to deliver the package of essential interventions, and continue to
strengthen the focus on key nutrition behaviour such as complementary feeding.
LESSON 2: POSHAN ABHIYAAN HAS ENABLED A NATION-WIDE JAN
ANDOLAN CATALYSING NUTRITION RELATED BEHAVIOUR CHANGE
AT SCALE FOR POSITIVE IMPACT ON FEEDING AND HEALTH CARE
PRACTICES
Jan Andolan, has been an integral part of POSHAN Abhiyaan. It was conceptualized to
engage the community and support behaviour change for nutrition through a people’s
movement with the ownership of the efforts being vested in the community rather than
only in government delivery mechanisms.
POSHAN Maahs and Pakhwadas were celebrated with great enthusiasm involving all
stakeholders, such as civil society organizations, academic institutions, PRIs and self-
help group (SHG) members. These celebrations of POSHAN Maah and Pakhwadas have
demonstrated the power of cross-sectoral outreach for behaviour change communication.
A focused and coherent SBCC Action Plan with standard messages is essential to take
the work of POSHAN Abhiyaan forward. While the Jan Andolan activities are being
organized with great zeal, it is imperative that such fervour continues throughout the
year and beyond the designated months to facilitate behaviour change.
Despite successful implementation of the campaigns, the key platforms to reach households
and children in the first 1,000 days should continue to be home visits, supplemented by
community-based events and mass media. Jan Andolan could effectively be utilized to
change community level awareness of normative behaviours through concerted messages.
The messaging has to be complemented with strengthened delivery systems to implement
interventions so that the demand for services from the sensitized communities could be
met.
In extending the Jan Andolan, engagement with elected representatives at all levels–
from the Parliament to the Panchayats along with local partners–could be a next step to
ensure continuity of enabling environment for behaviour change communication as well
as synchronized and unified messaging.
Adopting healthy and nutrition behaviours requires more than knowledge; therefore,
looking forward, it is critical to invest in understanding household constraints to behaviour
change, their access to knowledge and other resources to support behaviour change, and
to ensure that the Jan Andolan and other behaviour change efforts of POSHAN Abhiyaan
are coupled with additional strategies that remove more barriers.
Key Takeaways from POSHAN Abhiyaan
101 Building on this momentum, Jan Andolan should be intensified using high reach
platforms such as home visits, community-based events, mass media and more with
even greater participation of families and communities.
LESSON 3: POSHAN ABHIYAAN DEMONSTRATED THAT
THE PROCESSES FOR INTER-SECTORAL CONVERGENCE
ARE EFFECTIVELY OPERATIONALIZED THROUGH IN PLACE
INSTITUTIONAL MECHANISMS AT MULTIPLE LEVELS
Malnutrition is multi-factorial in nature, and the outcomes of malnutrition are affected
by actions in different sectors. It is well recognized that a multi-sectoral approach is
therefore essential. Several sectoral policies and programmes exist in India that need to
be effectively implemented to ensure reach to the intended beneficiaries. Recognizing
the multi-sectoral nature of the malnutrition challenge, convergence was identified as
one of the enabling activities for ensuring effective delivery of all sectoral interventions
to households in the first 1,000 days.
POSHAN Abhiyaan conceptualized convergence at two levels:
1. Governance level, which creates institutional mechanisms to ensure coherent
engagement with multiple departments; and
2. Impact level where “effective convergence” implies successful reach of programmes
from relevant sectors that address the key determinants of under-nutrition for the
same household, same woman and same child in the first 1,000 days (from pre-
conception until the child’s second birthday).
The governance level of convergence has been put in place quite firmly with POSHAN
Abhiyaan. At this level, after the development of convergence action plans (CAP), States,
Districts and Blocks are expected to conduct quarterly review meetings to examine
progress and identify actions to meet the targets specified in the action plans. However,
it has been found that discussions during such meetings are generic. In addition, CAP
committees at lower levels are less empowered to take financial and operational decisions
to close implementation gaps. It is challenging to monitor the multiple data reporting
structures across different departments, using multiple data platforms, for the same set
of beneficiary households, mothers and children. Therefore, it is important to examine
the reporting structures and data platforms to optimize and reduce the burden and
improve functionality for decision making. At the frontline, to ensure coordination and
convergence between the Anganwadi workers, ASHA, and ANMs in delivering the services
through clear and coordinated directives from the state and district levels.
Although the overarching intent of convergence is clear, the operational guidance does
not make it explicit how stakeholders could ensure that multiple programmes reach the
same mother–child dyad in the first 1,000-day period. The success of POSHAN Abhiyaan’s
convergent action planning efforts will lie in the ability of the convergence-related
processes to trigger the within- and across-sector actions that lead to effective reach
of an agreed upon core set of interventions to all households in the 1,000-day period.
102
Key Takeaways from POSHAN Abhiyaan Convergence can only be successful when all interventions reach all target households
in the right timeframes. Therefore, it is important to identify a core set of indicators of
successful convergence that can be monitored and supported through CAP so that the
review meetings become meaningful and enable progress tracking and programmatic
support to ensure that the intent of convergence is fully met.
Institutional mechanisms that worked for intersectoral coordination must be strengthened
and extended to build coalition on ground with other departments such as agriculture,
school education, and more.
LESSON 4: POSHAN ABHIYAAN SHOWED THAT TECHNOLOGY CAN
BE LEVERAGED FOR REAL TIME MONITORING OF LARGE SCALE
HEALTH AND NUTRITION PROGRAMMES
Integrated Child Development Services-Common Application Software (ICDS-CAS) was
introduced in POSHAN Abhiyaan, to facilitate real time monitoring for improving service
delivery and programme management through an innovative web and mobile-phone
based application. Although there were delays in the initial roll-out ICDS-CAS with low
fund utilization, by September 2020, ICDS-CAS had been rolled out in 29 States with 359
districts of the country. Additionally, 48% Anganwadi Workers had received smartphones
and 56% Lady Supervisors had received smartphones as of September 2020. Thus, the
technological intervention was not fully implemented across the country to completely
assess its effects. Additionally, many States would need to accelerate access to mobile
phones and training of providers and managers. The gaps in network issues, capacity
building and supportive systems such as help desks need attention.
In addition to the procurement issues, ICDS-CAS also faced numerous other challenges.
Firstly, roll-out of ICDS-CAS remained slow due to network issues in many districts.
Secondly, majority of the AWWs using mobile/tablets continued to maintain records
manually as well, which led to duplication of work. Also, there is very little evidence to
suggest effective use of data collected on CAS for programme monitoring and course
correction. The challenges pertaining to ICDS-CAS limited its effectiveness. Therefore,
ICDS-CAS has now been replaced by POSHAN Tracker – a robust ICT enabled platform, to
improve governance with regard to real-time monitoring of provisioning of supplementary
nutrition for prompt supervisions and management of services has been rolled out
successfully across all States/UTs covering all districts. Key points to consider to ensure
the success of POSHAN Tracker are to address upfront the network, cloud storage and
other technological challenges identified in rolling out ICDS-CAS. In addition, duplication
of record keeping (paper and phone) must be limited to save time and enhance the
effectiveness of AWWs. To support convergence, creating linkages and other approaches
to enable data sharing by both the health and ICDS systems is essential, as they share
the same beneficiaries. This could further help in avoiding duplication of efforts, and
improve monitoring. Finally, sharpening data use within the ICDS and across the ICDS
and other systems in the context of POSHAN Abhiyaan is critical to enable data-driven
actions. Regardless of the source of the data, data use is a critical step in improving the
impact of technology-enabled data gathering.
Key Takeaways from POSHAN Abhiyaan
103 Sustained, comprehensive and multidimensional use of technology platforms for
educating, counselling, on-site decision making, and work and task planning are all
essential to realize the full impact of technology. Additionally, leveraging the use of
data in showing clips and movies during home visits to the beneficiaries to further bring
about behaviour change is another area for expanding POSHAN Abhiyaan.
LESSON 5: POSHAN ABHIYAAN SUPPORTED THE RESILIENCE OF
HEALTH AND NUTRITION SYSTEMS DURING COVID-19 PANDEMIC
The nation-wide lockdown imposed to curb the spread of the COVID-19 pandemic in
March-April 2020 resulted in disruption in service delivery of many key health and nutrition
services included under the POSHAN Abhiyaan umbrella framework of intervention during
the second quarter of 2020. However, analysis of administrative data has demonstrated
that services restored to near pre-pandemic levels by December 2020, demonstrating the
resilience of health and nutrition systems of the country. It is likely that this restoration
was due to the high salience of nutrition on the policy agenda in the pre-COVID era.
To continue the delivery of essential health and nutrition services to women and
children along with following protocol, several policy adaptations and interventions
were undertaken by MWCD and MoHFW. Although platforms like Anganwadi Centres
were not operational during the peak of pandemic, several services were delivered to
the beneficiaries at their doorstep during home visits. One such example is the ICDS
supplementary nutrition programme (take-home rations), which was almost equal to the
pre-pandemic levels even during the lockdown period of April-June 2020, because the
services were delivered to the homes of the beneficiaries. Many States and UTs also added
additional rations to provide extra care to the beneficiaries amid COVID-19 pandemic.
VHSNDs were also conducted in a staggered approach and in non-containment zones
to expand access to ICDS services for beneficiaries and reduce the spread of COVID-19.
Similarly, as many health facilities were trying to address the ongoing pandemic, the
maternal and child health services were available on-demand, walk-in, or during home-
visits. Operational guidelines were also issued to the hospitals for conducting essential
procedure for pre and post pregnancy.
Such measures and adaptations that were taken at the State- and Central-levels indicate
that the Abhiyaan supported the continuation of service delivery despite the pandemic,
and the commendable efforts undertaken by FLWs to provide essential services during
the lock-down and immediately after, contributing to service restoration.
Despite these efforts, in the context of the continuing impacts of the COVID-19 pandemic,
millions of babies born in 2020 have likely missed several essential interventions in
health and nutrition. Since data are not available from ground-up surveys, there remains
uncertainty about the impact on client populations for the programmes. However, the
broad system-wide commitment to nutrition in the range of efforts to restore health and
nutrition services was apparent across Ministries, across States and across development
partners. Continued attention to ensure rapid and full restoration of services as well as
new adaptations to services in the continuing pandemic is critical to the core POSHAN
104
Key Takeaways from POSHAN Abhiyaan Abhiyaan goal of delivering essential evidence-based interventions to all women and all
children.
In addition, the pandemic has induced economic and food distress that must be tackled
to accelerate progress on nutrition. Improving nutrition is difficult, if not impossible, when
families are in economic distress. Nutrition-sensitive social protection could therefore play
a key role in putting families back on the path to being able to provide better nutrition
for their children. Therefore, all available social safety net and health/nutrition services
– whether special services in the context of the pandemic or routine services – should
be reaching families in the first 1000 days in a timely and targeted manner. This will also
help to achieve convergence goals for the mission.
Innovative approaches to ensure service delivery of the essential health and nutrition
services is needed to further improve quality, strengthening the system, and re-
energizing the existing programme to tackle the pandemic.
REFLECTION ON POSHAN ABHIYAAN BASED ON EARLY RESULTS
AVAILABLE FOR 22 STATES FROM NFHS-5
The early results from POSHAN Abhiyaan has highlighted that there has been an
improvement in some of the immediate and underlying determinants, and the coverage
of the intervention. The comparison of the NFHS-4 (2015-16) to NFHS-5 (2019-20) for
22 states for which factsheets are available, have painted a mixed picture. Many States
have witnessed an improvement in the immediate determinants like infant and child
feeding practices, along with consistent improvement in the underlying determinants like
water and sanitation, and women’s education and early marriage. There has also been an
improvement in the coverage of interventions like IFA, institutional births, immunisation,
Vitamin A, and diarrhoea cases treated with ORS and zinc. Due to the multi-factorial
nature of malnutrition, the improvement in determinants and coverage highlights that the
Mission has been able to facilitate positive results. Despite these improvements, it should
be noted that the outcome indicators have slowed down and in fact worsened in some
States. This calls for conducting deeper analysis of NFHS-5 to provide better insights on
the plausible factors that could have resulted in slowing down and understanding the
role of immediate and underlying determinants.
In conclusion, the POSHAN Abhiyaan has been a success in terms of creating a momentum
among the beneficiaries through Jan Andolan, bring focus towards the importance of first
1,000 days along with providing a package of interventions for the same, demonstrating
convergence between different line ministries, leveraging the use of technology for real-
time monitoring of nutrition and health, and highlighting resilience amid pandemic.
Key Takeaways from POSHAN Abhiyaan
105 References
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addressing malnutrition: What will it take? POSHAN Policy Note 34. New Delhi:
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107 10. Dhami, M.V., F.A. Ogbo, U.L. Osuagwu, and K.E. Agho. 2019. “Prevalence and Factors
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108
References Annexures
ANNEXURE 1A: STATE TEMPLATE-WOMEN AND CHILD
DEVELOPMENT
Fourth POSHAN Abhiyaan Monitoring Report: Data Collection Form
WCD TEMPLATE
[Kindly fill information and share latest by 25th Sept 2020]
1. Name of the State/UT: ………………………………………………………………...
2. Total number of Districts in the State: ………………………………………………………………...
3. Total number of Districts with ICDS-CAS: ………………………………………………………………...
4. Total number of Blocks in the State: ………………………………………………………………...
5. Total number of Blocks with ICDS-CAS: ………………………………………………………………...
6. Total number of Villages in the State: ………………………………………………………………...
7. Total number of AWC in the State/UT: ………………………………………………………………...
8. If UT, does the UT have a State Legislature? Yes || No
HUMAN RESOURCE
HUMAN RESOURCE- POSHAN Abhiyaan (as on 31
st
March 2020)
A Joint Project Coordinator
No. of posts sanctioned
No. of posts filled
B Consultant
No. of posts sanctioned
No. of posts filled
C Project Associate
No. of posts sanctioned
No. of posts filled
109 SECTION I:
NOTE: You are requested to share our response separately for two months
March 2020 July 2020
A. TRAINING & CAPACITY BUILDING
1.1
No. of District level Resource Groups
(DRGs) for ILA training been established
1.2
No. of Block level Resource Groups (BRGs)
for ILA training been established
1.3Total no. of AWWs enrolled for e-ILA
1.4
No. of enrolled AWWs who have completed
e-ILA training
1.5
Total no. of Lady Supervisors enrolled for
e-ILA
1.6
No. of enrolled Lady Supervisors who have
completed e-ILA training
1.7
Staff trained on ICDS-CAS Dashboard/Mobile
StaffMarch 2020 July 2020
ADPOs
BCDPOs
CLSs
DAWW
1.8No. of AWWs who have started entry in ICDS-CAS till July 2020:
March 2020July 2020
1.9
Staff trained on
ILA
Nos. Trained
No. of modules
Nos.
Trained
No. of modules
Less
than 7
7-15
More
than 15
Less
than 7
7-15
More
than 15
A
State Level (SRG
members)
B
District Level
(DRG members)
C
Block Level
(BRG members)
D
Sector Level
(AWWs)
B. Convergence
1.10
A
Has State/UT
submitted the
Convergence
Action Plan
(CAP) to CPMU
for FY 2020-
21 (If no, give
reason)
Yes ||
No ||
110
Annexures B
No. of Districts
in which CAP
has been formed
No. of
Districts:
C
No. of
Districts held
Convergence
Committee
meeting for the
1
st
Quarter of FY
2020-21
No. of
Districts:
D
No. of Districts
developed
&submitted CAP
for FY 2020-21
No. of
Districts:
SECTION II:
NOTE: You are requested to share our response separately for two months
March 2020 July 2020
A. PROGRAMME ACTIVITES- ICDS
2.1
Total number of pregnant women enrolled
for Anganwadi services
2.2
No. of pregnant women who received THR
for:
15-21 days
> 21+ days
2.3
Total number of lactating women enrolled
for Anganwadi services
2.4
No. of lactating women who received THR
for:
15-21 days
> 21+ days
2.5
Total number of children 6-36 months old
enrolled for Anganwadi services
2.6
No. of children 6-36 months old who
received THR for:
15-21 days
> 21+ days
2.7
Total number of children 3 yr-6 yr old
enrolled for Anganwadi services
2.8
No. of children 3 yr-6 yr old who received
hot-cooked meal for:
15-21 days
> 21+ days
Annexures
111 2.9
Total number of children 0-5 years old
enrolled for Anganwadi services
2.10
No. of children 0-5 years old who were
weighed
2.11
No. of children 0-5 years old whose height
was taken (measured)
B. Output Indicators- ICDS
2.12
% of newborns with low birth weight
(< 2500 gms)
2.13
% of children 0-5 years who were
moderately stunted (height-for-age)
2.14
% of children 0-5 years who were severely
stunted (height-for-age)
2.15
% of children 0-5 years who were
moderately underweight (weight-for-age)
2.16
% of children 0-5 years who were severely
underweight (weight-for-age)
2.17
% of children 0-5 years with moderately
acute malnutrition (weight-for-height)
2.18
% of children 0-5 years with severely
acute malnutrition (weight-for-height)
2.19
% of children who were initiated
breastfeeding within one hour of birth.
2.20
% Infants 0-6 months of age who are fed
exclusively with breast milk.
2.21
% Children from 6–24 months who were
initiated timely complementary feeding
along with continued breastfeeding
2.22
% Children from 6–24 months consuming
adequate diet
C. HOME VISITS by AWW
2.27
Out of the mandated number of home
visits, the % of home visits made by AWWs
2.28
% of home visits to household with
pregnant mothers to counsel on
appropriate practices during pregnancy
2.29
A.
PMMVY scheme
No. of pregnant women targeted
B.
No. of pregnant women benefited as per
the entitlement
2.30
% of home visits to household with young
infant (less than 6 month) to counsel on
Importance of immediate breastfeeding,
initiation of complementary feeding and
continued breastfeeding
112
Annexures D. During COVID-19 times
2.31
Please specify, any innovative techniques
applied for providing services (March –
July 2020) during COVID-19 19 times
Provide the innovations in brief
(if required, place the annexure for
details)
A Counselling
B Growth Monitoring
C Community Based Events (CBEs)
D Pre-school Education
E Additional food provided other than THR
2.32
In how many Districts, AWW is involved
in contact tracing of the migrant workers
who came back from other cities?
2.33
During COVID-19 times, mention on what
all other activities AWW is involved in?
1.
2.
3.
SECTION III: INNOVATION & FLEXI-PLAN
SnStatus of Flexi-Plan
3.1a. Constitution
of State Level
Sanctioning
Committee
(SLSC)
(Y/N)
(if no, reason
and timeline)
b. Date of
Meeting of
SLSC held
(if no,
reason
and
timeline)
c. Status of
implementation
(Detailed
Activities)
d. Funds
earmarked
(In lakh Rs.)
e. Funds
utilised
(In lakh
Rs.)
f. Balance
Funds
to be
utilized
(timeline
also to be
given)
SNSTATUS OF INNOVATION
3.2a.
Innovation
plan
prepared
(Y/N)
(if no,
reason and
timeline)
b. Date of
Meeting of
SLSC held
(if no,
reason and
timeline)
c. Approval
of
Committee
obtained
(if no,
reason and
timeline)
d. Status
of imple-
mentation
and details
of major
activities
e. Funds
earmarked
(In lakh
Rs.)
f. Funds
utilised
(In lakh
Rs.)
g. Balance
Funds to
be utilized
(timeline
also to be
given)
Annexures
113 SECTION IV: ADDITIONAL INFORMATION
SnInformation Required
4.1Specify the main challenges faced in implementation of POSHAN Abhiyaan at State/
UT level during COVID-19 Times:
(Provide details as attachment)
i. ICDS_CAS
ii. ILA & e-ILA
iii. HR
iv. Growth Monitoring Devices
v. Convergence
vi. Jan Andolan/ Community Mobilization
vii. Any other
4.2 Specify the good practices or innovations State/UT has done in the year 2020 to
improve the nutrition indicators during the first 1000 days life cycle especially in
COVID-19 times:
(Provide details as attachment)
114
Annexures ANNEXURE 1B: STATE TEMPLATE-HEALTH
FOURTH POSHAN Abhiyaan Monitoring Report: Data Collection
Form
Health Template
[Kindly fill information and share latest by 25 Sept 2020]
1. Name of the State/UT:…………………………………………..
2. Total number of Districts in the State: …………………………………………..
3. Total number of Blocks in the State: …………………………………………..
4. Total number of Villages in the State: …………………………………………..
5. If UT, does the UT have a State Legislature? Yes || No
SECTION I:
Sn Information RequiredResponse
A. INFRASTRUCTURE
1.1Number of Health Facilities in the State/UT- (as on 31st March 2020)
CHCsNo. sanctioned
No. functional
No. functional as FRU
PHCsNo. sanctioned
No. functional
Additional PHCsNo. sanctioned
No. functional
Sub CentresNo. sanctioned
No. functional
Health and Wellness Centres
(HWC)
No. sanctioned
No. functional
1.2Provide details for HWCs (as on 31st March 2020)
Total no. HWCs planned
No. of HWCs operational
No. of HWCs providing ALL
the proposed services
B. HUMAN RESOURCES (as on 31st March 2020)
1.3 a. Lady Health Visitor (LHV)No. of posts sanctioned
No. of LHVs in position
b. ANMNo. of posts sanctioned
Annexures
115 No. of ANMs in position
c. ASHA Facilitators Total no. in State/UT
No. of ASHAs per facilitator
d. ASHATotal no. of ASHAs working
in State/UTs
SECTION II:
NOTE: You are requested to share your response separately for two months
March 2020 July 2020
A. PROGRAMME AND OUTPUT ACTIVITES- NHM
2.1 ATotal no. of pregnant women
BTotal no. of lactating women
CTotal no. of children 6-59 months
DTotal no. children 12-23 months
ETotal number of children 5-9 years
FTotal no. of adolescent girls 10-19 years
G
Total number of out of school adolescent girls
10-19 years
2.2
Total no. of pregnant women who registered
for ANC in the first trimester(i.e. in the first 12
weeks of pregnancy)
2.3
Total no. of pregnant women who received 4 or
more ANC check-ups
2.4 Total no. of pregnant women given TT2/booster
2.5
Total no. of pregnant women given one
albendazole tablet after first trimester
2.6
Total number of pregnant women given 180 IFA
tablets during ANC
2.7 Total no. of institutional deliveries
2.8
Total number of lactating women given 180 IFA
tablets
2.9
Total no. of children 12-23 months completely
immunized
2.10
Total no. of children 6-59 months who were
provided at least 8-10 doses of IFA syrup per
month against the target population
2.11
Total number of children 5-9 years (girls and
boys) given weekly IFA supplementation per
month against the target population
116
Annexures 2.12
Total number of children 10-19 years (girls and
boys) given weekly IFA supplementation per
month against the target population
2.13
Total no. of children (9-23 months) who have
received 1st dose of Vitamin-A supplementation
2.14
Total no. of diarrhoea episodes reported in
children 0 to 59 months of age
2.15
Total no. of deaths reported due to childhood
(0-59 months) diarrhoea
2.16
Total no. of childhood diarrhoea cases treated in
the facility (inpatient)
2.17
Total no. of diarrhoea episodes reported in
children 0 to 59 months of age where only ORS
was given
2.18
Total number of childhood (0-59 months)
diarrhoea cases reported treated with ORS and
zinc
2.19
Total no. Number of newborn breastfed
within one hour of birth (Early initiation of
breastfeeding)
2.20
No. of children 6 to 59 months suffering from
ANY anaemia
2.21
No. of adolescent girls 15-19 years suffering from
ANY anaemia
2.22
No. of pregnant women suffering from ANY
anaemia
2.23 AMB programme update
AHas IFA been included in the EDL?Completed/In process/ Remark
B
Has the State procured digital invasive
hemoglobinometers
Completed/In process/ Remark
B. HOME VISITS by ASHAs (DURING COVID-19 TIMES) MARCH -JULY 2020
2.24
Out of the mandated number of home visits, the
% of home visits made by ASHA during March-
July 2020
2.25
% of home visits to household with pregnant
mothers to counsel on appropriate practices
during pregnancy during March-July 2020
2.26 % of HBNC home visits in March-July 2020
2.27
Please specify, any innovative techniques applied
for providing services like
Provide the innovations in brief
(if required, place the annexure
for details)
ACounselling
BImmunization
Annexures
117 CIFA (syrup, pink, red, blue) distribution
DORS and zinc distribution
ETotal sick SAM admission at NRC
F
Total sick SAM children discharged with target
with gain at NRC
2.28
In how many Districts, ASHAs is involved in
contact tracing of the migrant workers who
came back from other cities?
2.29 During COVID-19 times, mention on what all
other activities ASHAs are involved in?
1.
2.
3.
4.
5.
SECTION III:
SNINFORMATION REQUIREDRESPONSE
3.1 Specify the main challenges faced in
implementation of POSHAN Abhiyaan at State/
UT level during COVID-19 Times:
(Provide details as attachment)
118
Annexures ANNEXURE 2: RUBRIC
Theme Sub- Theme
Indicators (as per Template)
-USING ONLY MAR 2020 DATA
Weights
(TOTAL=100)
WCD template TOTAL-5050
Governance & Institutional Mechanism 12
1.1 Fund Allocation3
% utilized by the State/ UT (as on
July, 2020)
0 if <25%
1 if 25%-<50%
2 if 50%-<75%
3 if ≥ 75%
1.2 Constitution of Committees and Resource Groups9

% of districts where DRGs have
been formed–Section 1–A- 1.1 A1.2
0 if <25%
1 if 25%-<50%
2 if 50%-<75%
3 if ≥ 75%

% of blocks where BRGs have
been formed Section 1–A–1.2
0 if <25%
1 if 25%-<50%
2 if 50%-<75%
3 if ≥ 75%

% of districts where the CAP
committees have been formed–
Section 1–B–1.10 B
0 if <25%
1 if 25%-<50%
2 if 50%-<75%
3 if ≥ 75%
Strategy and Planning3

Has the State/UT level CAP been
submitted to CPMU for the year
2020-21- Section 1 B–1.10A
1 if YES; 0 if NO
% of districts that developed and
submitted CAP for the year 2020-
21- Section 1 B–1.10D
0.5 if <25%
1 if 25%-<50%
1.5 if 50%-<75%
2 if ≥ 75%
Inputs for Service Delivery & Capacities 23
3.1 HR6

% of joint project coordinator
positions filled–HR–QA
0.5 if <25%
1 if 25%-<50%
1.5 if 50%-<75%
2 if ≥ 75%
Annexures
119 Theme Sub- Theme
Indicators (as per Template)
-USING ONLY MAR 2020 DATA
Weights
(TOTAL=100)
% of consultant positions filled
-HR–QB
0.5 if <25%
1 if 25%-<50%
1.5 if 50%-<75%
2 if ≥ 75%
% of project associate positions
filled -HR–QC
0.5 if <25%
1 if 25%-<50%
1.5 if 50%-<75%
2 if ≥ 75%
Supplies 5

Mobile phones
% of mobile phones distributed to
districts
0.25 if <25%
0.5 if 25%-<50%
0.75 if 50%-<75%
1 if ≥ 75%
Growth monitoring
devices
% of weighing scales-infant
distributed
0.25 if <25%
0.5 if 25%-<50%
0.75 if 50%-<75%
1 if ≥ 75%
% of weighing scales-adult
distributed
0.25 if <25%
0.5 if 25%-<50%
0.75 if 50%-<75%
1 if ≥ 75%
% of infantometers distributed
0.25 if <25%
0.5 if 25%-<50%
0.75 if 50%-<75%
1 if ≥ 75%
% of stadiometers distributed
0.25 if <25%
0.5 if 25%-<50%
0.75 if 50%-<75%
1 if ≥ 75%
Training and capacity building12
% of LS who completed training on
e-ILA modules - Section 1. A. -1.6.
0 if <25%
1 if 25%-<50%
2 if 50%-<75%
3 if ≥ 75%
120
Annexures Theme Sub- Theme
Indicators (as per Template)
-USING ONLY MAR 2020 DATA
Weights
(TOTAL=100)
% of AWWs who completed
training on e-ILA modules Section
1. A. -1.4
0 if <25%
1 if 25%-<50%
2 if 50%-<75%
3 if ≥ 75%








% of CDPOs who were trained on
dashboard/mobile -Section IA.
1.7B.
0 if <25%
1 if 25%-<50%
2 if 50%-<75%
3 if ≥ 75%
% of LS who were trained on
dashboard/mobile - Section IA.
1.7C.
0 if <25%
1 if 25%-<50%
2 if 50%-<75%
3 if ≥ 75%
Programme activities and intervention coverage12
4.1 Programme activities- ICDS12
















% of pregnant women who
received THR for 21+ days-
Section II. 2.2.
0 if <25%
1 if 25%-<50%
2 if 50%-<75%
3 if ≥ 75%
% of lactating women who
received THR for 21 + days-
Section II. 2.4.
0 if <25%
1 if 25%-<50%
2 if 50%-<75%
3 if ≥ 75%
% of children 6-36 months who
received THR for 21+ days -
Section II. 2.5.
0 if <25%
1 if 25%-<50%
2 if 50%-<75%
3 if ≥ 75%
% of children 0-5 years who were
weighed-Section 2 A. 2.10
0 if <25%
1 if 25%-<50%
2 if 50%-<75%
3 if ≥ 75%
HEALTH TEMPLATE TOTAL-5050
Service delivery essentials12
1.1 Infrastructure 9
Annexures
121 Theme Sub- Theme
Indicators (as per Template)
-USING ONLY MAR 2020 DATA
Weights
(TOTAL=100)


% of sub centres functional.
Section 1 A. 1.1B
0 if <25%
1 if 25%-<50%
2 if 50%-<75%
3 if ≥ 75%

% of CHCs functional Section 1 A.
1.1A
0 if <25%
1 if 25%-<50%
2 if 50%-<75%
3 if ≥ 75%

% of HWC functional Section 1 A.
1.1E
0 if <25%
1 if 25%-<50%
2 if 50%-<75%
3 if ≥ 75%
1.2 Human Resource 3

% of ANM posts filled–Section I-B
1.3b
0 if <25%
1 if 25%-<50%
2 if 50%-<75%
3 if ≥ 75%
Programme activities and intervention coverage38
2.1 Programme activities36
















% of newborn breastfed within
one hour of birth–Section 2 A–2.19
[ Data for live births from NITI]
0 if <25%
1 if 25%-<50%
2 if 50%-<75%
3 if ≥ 75%
% of children (12-23 mo) fully
immunized in–Section 2 A–2.9.
0 if <25%
1 if 25%-<50%
2 if 50%-<75%
3 if ≥ 75%
% of children (6-59 mo) who were
provided at least 8-10 doses of
IFA syrup per month–Section 2
A–2.10.
0 if <25%
1 if 25%-<50%
2 if 50%-<75%
3 if ≥ 75%
% of pregnant women who
registered for ANC in the first
trimester–Section 2 A–2.2.
0 if <25%
1 if 25%-<50%
2 if 50%-<75%
3 if ≥ 75%
122
Annexures Theme Sub- Theme
Indicators (as per Template)
-USING ONLY MAR 2020 DATA
Weights
(TOTAL=100)
% of pregnant women who
received 4 or more ANCs–Section
2 A–2.3.
0 if <25%
1 if 25%-<50%
2 if 50%-<75%
3 if ≥ 75%
% of pregnant women who were
given 180 IFA tablets Mar 2020-
Section 2 A–2.6
0 if <25%
1 if 25%-<50%
2 if 50%-<75%
3 if ≥ 75%
% of lactating women who were
given 180 IFA tablets–Section 2
A–2.8
0 if <25%
1 if 25%-<50%
2 if 50%-<75%
3 if ≥ 75%
% of 5-9 years children who were
given weekly IFA tablets–Section
2 A–2.11
0 if <25%
1 if 25%-<50%
2 if 50%-<75%
3 if ≥ 75%
% of pregnant women given TT2/
booster in Mar 2020/ Section 2 A
-2.4
0 if <25%
1 if 25%-<50%
2 if 50%-<75%
3 if ≥ 75%
% of pregnant women given one
Albendazole tablet after first
trimester -Section 2 A–2.5
0 if <25%
1 if 25%-<50%
2 if 50%-<75%
3 if ≥ 75%
% of children (0–59 months)
diarrhoea cases reported treated
with ORS and Zinc–Section 2
A-2.18
0 if <25%
1 if 25%-<50%
2 if 50%-<75%
3 if ≥ 75%
% of home visits to household
with pregnant mothers to counsel
on appropriate practices during
pregnancy during March-July
2020; Section 2 B-2.25
0 if <25%
1 if 25%-<50%
2 if 50%-<75%
3 if ≥ 75%
2.2 AMB strategy 2
Annexures
123 Theme Sub- Theme
Indicators (as per Template)
-USING ONLY MAR 2020 DATA
Weights
(TOTAL=100)

Has IFA been included in the EDL?
Section 2 A -2.23A
0 Yet to begin
0.5 In process
1 Completed
Has the State procured digital
invasive hemoglobinometers
Section 2 A -2.23B
0 Yet to begin
0.5 In process
1 Completed
124
Annexures ANNEXURE 3: STATE SCORE DASHBOARD OVERALL
 
  WCD
Domain
1:
Gover-
nance &
Institu-
tional
Mecha-
nism
WCD
Domain
2:
Strategy
and
Planning
WCD
Domain
3:
Service
Delivery
& Capac-
ities
WCD Do-
main 4:
Program
activi-
ties and
inter-
vention
coverage
Overall
WCD
score_
Sum
of all 4
domains
Health
Domain
1:
Service
delivery
essen-
tials
Health
Domain
2:
Program
activi-
ties and
inter-
vention
coverage
Overall
Health
score:
Sum of 2
domains
Total
imple-
mentation
score
 Max value 12 3 23 12 50 12 38 50 100
Large
States
Andhra
Pradesh
10.003.00 22.0012.0047.0012.0028.0040.0087.00
Assam 1.00 1.50 9.50 9.00 21.0011.0030.5041.5062.50
Bihar 10.003.00 19.006.00 38.006.00 16.5022.5060.50
Chattisgarh10.002.50 9.25 12.0033.7511.0027.5038.5072.25
Gujarat 10.003.00 23.0012.0048.0012.0025.5037.5085.50
Haryana 11.003.00 6.50 9.00 29.5010.0030.0040.0069.50
Himachal
Pradesh
11.003.00 17.2511.0042.259.00 31.5040.5082.75
Jharkhand 10.003.00 12.0011.0036.0011.0026.5037.5073.50
Karnataka 10.003.00 9.00 12.0034.0012.0029.0041.0075.00
Kerala 11.001.50 14.759.00 36.2512.0016.0028.0064.25
Madhya
Pradesh
10.003.00 19.2512.0044.2510.0028.5038.5082.75
Maharashtra11.002.00 20.5012.0045.5010.0032.0042.0087.50
Odisha 9.00 2.00 9.25 12.0032.2511.0031.0042.0074.25
Punjab 9.00 2.00 5.75 11.0027.759.00 11.0020.0047.75
Rajasthan 10.003.00 17.759.00 39.7510.0017.0027.0066.75
Tamil Nadu 11.003.00 22.5012.0048.5010.0024.5034.5083.00
Telangana 10.003.00 10.5010.0033.5011.0031.0042.0075.50
Uttar Pradesh10.003.00 14.005.00 32.009.00 25.5034.5066.50
Uttarakhand10.001.50 11.009.00 31.5010.0026.5036.5068.00
Small
States
Arunachal
Pradesh
9.00 3.00 3.75 0.00 15.759.00 11.5020.5036.25
Goa 4.00 1.50 6.50 12.0024.0012.0020.0032.0056.00
Manipur 2.00 0.00 1.25 0.00 3.25 10.0014.0024.0027.25
Meghalaya 12.003.00 19.0011.0045.0011.0012.5023.5068.50
Mizoram 11.003.00 12.0011.0037.000.00 0.00 0.00 37.00
Nagaland 12.003.00 17.001.00 33.0011.007.00 18.0051.00
Sikkim 11.003.00 18.7512.0044.7511.0025.5036.5081.25
Tripura 9.00 3.00 14.5012.0038.5010.0013.5023.5062.00
UTs
Andaman &
Nicobar
4.00 1.50 21.5012.0039.0011.0026.0037.0076.00
Chandigarh 10.003.00 23.0012.0048.009.00 23.0032.0080.00
D & N Haveli &
Daman & Diu
10.002.00 23.0012.0047.0012.0028.0040.0087.00
Delhi 8.00 1.00 14.5012.0035.509.00 15.5024.5060.00
Jammu &
Kashmir
10.002.00 14.007.00 33.0011.0023.5034.5067.50
Ladakh 3.00 3.00 5.00 9.00 20.0010.0020.0030.0050.00
Lakshadweep11.003.00 11.5012.0037.5011.0015.0026.0063.50
Puducherry 7.00 2.50 6.50 8.00 24.0010.0020.5030.5054.50
Annexures
125 Governance & Institutional Mechanism, WCD
 
 % utilized
by the
State/ UT
(as on
March,
2020)
1.1: Fund
Allocation
% of
districts
where
DRGs
have been
formed
% of
blocks
where
BRGs
have been
formed
% of districts
where the
convergence
action plan
committees
have been
formed
1.2: Con-
stitution of
Commit-
tees and
Resource
Groups
Domain 1:
Gover-
nance &
Institution-
al Mecha-
nism
  Max value 3 3 3 3 3 9 12
Large
States
Andhra Pradesh 1.00 1.00 3.00 3.00 3.00 9.00 10.00
Assam 1.00 1.00 0.00 0.00 0.00 0.00 1.00
Bihar 1.00 1.00 3.00 3.00 3.00 9.00 10.00
Chattisgarh 1.00 1.00 3.00 3.00 3.00 9.00 10.00
Gujarat 1.00 1.00 3.00 3.00 3.00 9.00 10.00
Haryana 2.00 2.00 3.00 3.00 3.00 9.00 11.00
Himachal Pradesh2.00 2.00 3.00 3.00 3.00 9.00 11.00
Jharkhand 1.00 1.00 3.00 3.00 3.00 9.00 10.00
Karnataka 1.00 1.00 3.00 3.00 3.00 9.00 10.00
Kerala 2.00 2.00 3.00 3.00 3.00 9.00 11.00
Madhya Pradesh 1.00 1.00 3.00 3.00 3.00 9.00 10.00
Maharashtra 2.00 2.00 3.00 3.00 3.00 9.00 11.00
Odisha 0.00 0.00 3.00 3.00 3.00 9.00 9.00
Punjab 0.00 0.00 3.00 3.00 3.00 9.00 9.00
Rajasthan 1.00 1.00 3.00 3.00 3.00 9.00 10.00
Tamil Nadu 2.00 2.00 3.00 3.00 3.00 9.00 11.00
Telangana 1.00 1.00 3.00 3.00 3.00 9.00 10.00
Uttar Pradesh 1.00 1.00 3.00 3.00 3.00 9.00 10.00
Uttarakhand 1.00 1.00 3.00 3.00 3.00 9.00 10.00
Small
States
Arunachal Pradesh0.00 0.00 3.00 3.00 3.00 9.00 9.00
Goa1.00 1.00   3.00 0.00 3.00 4.00
Manipur 2.00 2.00       0.00 2.00
Meghalaya 3.00 3.00 3.00 3.00 3.00 9.00 12.00
Mizoram 2.00 2.00 3.00 3.00 3.00 9.00 11.00
Nagaland 3.00 3.00 3.00 3.00 3.00 9.00 12.00
Sikkim 2.00 2.00 3.00 3.00 3.00 9.00 11.00
Tripura 0.00 0.00 3.00 3.00 3.00 9.00 9.00
UTs
Andaman &
Nicobar
1.00 1.00     3.00 3.00 4.00
Chandigarh 1.00 1.00 3.00 3.00 3.00 9.00 10.00
D & N Haveli &
Daman & Diu
1.00 1.00 3.00 3.00 3.00 9.00 10.00
Delhi 2.00 2.00 3.00 3.00   6.00 8.00
Jammu & Kashmir1.00 1.00 3.00 3.00 3.00 9.00 10.00
Ladakh 0.00 0.00 0.00 0.00 3.00 3.00 3.00
Lakshadweep 2.00 2.00 3.00 3.00 3.00 9.00 11.00
Puducherry 0.00 0.00 2.00 3.00 2.00 7.00 7.00
Score: < 25% : 0 25%-50% : 1 50%-75% : 2 > 75% : 3
126
Annexures Strategy and Planning, WCD
  
Convergence action plan
submitted to CPMU for
the year 2020-21
% of districts that
developed and
submitted CAP for
the year 2020-21
Domain 2: Strategy
and Planning
  Max value123
Large States
Andhra Pradesh1.002.00 3.00
Assam1.000.50 1.50
Bihar1.002.00 3.00
Chattisgarh1.001.50 2.50
Gujarat1.002.00 3.00
Haryana1.002.00 3.00
Himachal Pradesh1.002.00 3.00
Jharkhand1.002.00 3.00
Karnataka1.002.00 3.00
Kerala0.001.50 1.50
Madhya Pradesh1.002.00 3.00
Maharashtra0.002.00 2.00
Odisha0.002.00 2.00
Punjab0.002.00 2.00
Rajasthan1.002.00 3.00
Tamil Nadu1.002.00 3.00
Telangana1.002.00 3.00
Uttar Pradesh1.002.00 3.00
Uttarakhand1.000.50 1.50
Small States
Arunachal Pradesh1.002.00 3.00
Goa1.000.50 1.50
Manipur  0.00
Meghalaya1.002.00 3.00
Mizoram1.002.00 3.00
Nagaland1.002.00 3.00
Sikkim1.002.00 3.00
Tripura1.002.00 3.00
UTs
Andaman & Nicobar1.000.50 1.50
Chandigarh1.002.00 3.00
D & N Haveli & Daman
and Diu
0.002.00 2.00
Delhi1.00 1.00
Jammu & Kashmir0.002.00 2.00
Ladakh1.002.00 3.00
Lakshadweep1.002.00 3.00
Puducherry1.001.50 2.50
Score: No : 0; Yes : 1 < 25% : 0 25%-50% : 1 50%-75% : 2 > 75% : 3
Annexures
127 Inputs for Service Delivery & Capacities, WCD
 
 
% of joint project
coordinator positions
filled
% of consultant
positions filled
% of project associate
positions filled
3.1: HR
% of mobile phones
distributed to districts
% of weighing scales-
infant distributed
% of weighing scales-
adult distributed
% of infantometers
distributed
% of stadiometers
distributed
3.2: Supplies
% of LS who
completed training on
e-ILA modules 
% of AWWs who
completed training on
e-ILA modules
% of CDPOs who were
trained on dashboard/
mobile
% of LS who were
trained on dashboard/
mobile
3.3: Training and
capacity building
Domain 3: Service
Delivery & Capacities
 
Max value
2
2
2
6
1
1
1
1
1
5
3
3
3
3
12
23
Large States
Andhra Pradesh
2.00
1.00
2.00
5.00
1.00
1.00
1.00
1.00
1.00
5.00
3.00
3.00
3.00
3.00
12.00
22.00
Assam
1.50
2.00
1.00
4.50
1.00
1.00
1.00
1.00
1.00
5.00
0.00
0.00
0.00
0.00
0.00
9.50
Bihar
2.00
2.00
2.00
6.00
1.00
1.00
1.00
1.00
1.00
5.00
2.00
0.00
3.00
3.00
8.00
19.00
Chattisgarh
0.50
2.00
1.50
4.00
0.75
0.50
0.50
0.25
0.25
2.25
1.00
0.00
1.00
1.00
3.00
9.25
Gujarat
2.00
2.00
2.00
6.00
1.00
1.00
1.00
1.00
1.00
5.00
3.00
3.00
3.00
3.00
12.00
23.00
Haryana
0.50
0.50
2.00
3.00
1.00
0.25
0.25
1.00
1.00
3.50
0.00
0.00
0.00
0.00
0.00
6.50
Himachal Pradesh
2.00
2.00
2.00
6.00
0.25
1.00
1.00
1.00
1.00
4.25
1.00
1.00
2.00
3.00
7.00
17.25
Jharkhand
2.00
0.50
1.50
4.00
1.00
1.00
1.00
1.00
1.00
5.00
0.00
0.00
2.00
1.00
3.00
12.00
Karnataka
1.00
2.00
1.50
4.50
0.50
1.00
1.00
1.00
1.00
4.50
0.00
0.00
0.00
0.00
0.00
9.00
Kerala
2.00
1.50
2.00
5.50
0.25
1.00
1.00
1.00
1.00
4.25
0.00
0.00
3.00
2.00
5.00
14.75
Madhya Pradesh
2.00
2.00
2.00
6.00
0.50
0.75
1.00
1.00
1.00
4.25
3.00
3.00
 
3.00
9.00
19.25
Maharashtra
2.00
1.00
1.50
4.50
1.00
1.00
1.00
1.00
1.00
5.00
3.00
3.00
2.00
3.00
11.00
20.50
Odisha
1.00
0.50
0.50
2.00
0.25
0.25
0.25
0.25
0.25
1.25
3.00
3.00
 
 
6.00
9.25
Punjab
0.50
0.50
0.50
1.50
0.25
1.00
1.00
1.00
1.00
4.25
0.00
0.00
 
0.00
0.00
5.75
Rajasthan
2.00
2.00
2.00
6.00
0.50
0.25
0.50
0.75
0.75
2.75
3.00
3.00
1.00
2.00
9.00
17.75
Tamil Nadu
2.00
2.00
1.50
5.50
1.00
1.00
1.00
1.00
1.00
5.00
3.00
3.00
3.00
3.00
12.00
22.50
Telangana
2.00
2.00
2.00
6.00
0.50
1.00
1.00
1.00
1.00
4.50
0.00
0.00
0.00
0.00
0.00
10.50
Uttar Pradesh
1.00
0.50
0.50
2.00
0.50
0.50
0.50
0.25
0.25
2.00
3.00
3.00
1.00
3.00
10.00
14.00
Uttarakhand
2.00
2.00
2.00
6.00
1.00
1.00
1.00
1.00
1.00
5.00
0.00
0.00
0.00
0.00
0.00
11.00
128
Annexures Small States
Arunachal Pradesh
0.50
1.50
0.50
2.50
0.25
0.25
0.25
0.25
0.25
1.25
0.00
0.00
 
 
0.00
3.75
Goa
0.50
0.50
0.50
1.50
1.00
1.00
1.00
1.00
1.00
5.00
0.00
0.00
0.00
0.00
0.00
6.50
Manipur
 
 
 
0.00
0.25
0.25
0.25
0.25
0.25
1.25
 
 
 
 
0.00
1.25
Meghalaya
2.00
1.00
2.00
5.00
1.00
1.00
1.00
1.00
1.00
5.00
3.00
0.00
3.00
3.00
9.00
19.00
Mizoram
2.00
2.00
2.00
6.00
1.00
1.00
1.00
1.00
1.00
5.00
0.00
0.00
0.00
1.00
1.00
12.00
Nagaland
2.00
2.00
2.00
6.00
1.00
1.00
1.00
1.00
1.00
5.00
0.00
0.00
3.00
3.00
6.00
17.00
Sikkim
2.00
0.50
2.00
4.50
0.75
0.25
0.25
0.75
0.25
2.25
3.00
3.00
3.00
3.00
12.00
18.75
Tripura
0.50
0.50
0.50
1.50
1.00
0.25
0.25
0.25
0.25
2.00
3.00
3.00
3.00
2.00
11.00
14.50
UTs
Andaman & Nicobar
0.50
2.00
2.00
4.50
1.00
1.00
1.00
1.00
1.00
5.00
3.00
3.00
3.00
3.00
12.00
21.50
Chandigarh
2.00
2.00
2.00
6.00
1.00
1.00
1.00
1.00
1.00
5.00
3.00
3.00
3.00
3.00
12.00
23.00
D & N Haveli & Daman & Diu
2.00
2.00
2.00
6.00
1.00
1.00
1.00
1.00
1.00
5.00
3.00
3.00
3.00
3.00
12.00
23.00
Delhi
2.00
1.00
0.50
3.50
1.00
1.00
1.00
1.00
1.00
5.00
0.00
0.00
3.00
3.00
6.00
14.50
Jammu & Kashmir
2.00
0.50
0.50
3.00
1.00
1.00
1.00
1.00
1.00
5.00
3.00
3.00
0.00
0.00
6.00
14.00
Ladakh
 
 
 
0.00
1.00
1.00
1.00
1.00
1.00
5.00
0.00
0.00
0.00
0.00
0.00
5.00
Lakshadweep
0.50
1.00
2.00
3.50
1.00
1.00
1.00
1.00
1.00
5.00
0.00
0.00
3.00
0.00
3.00
11.50
Puducherry
0.50
0.50
0.50
1.50
1.00
1.00
1.00
1.00
1.00
5.00
0.00
0.00
0.00
0.00
0.00
6.50
Score:
< 25% : 0
25%-50% : 1
50%-75% : 2
> 75% : 3
Annexures
129 Programme activities and intervention coverage, WCD
   
% of pregnant
women who
received THR
for 21+ days
% of lactating
women who
received THR
for 21+ days
% of children
6-36 mo who
received THR
for 21+ days
% of children
0-5 years
who were
weighed
Domain 4: Program
activities and
intervention
coverage
  Max value 3 3 3 3 12
Large States
Andhra Pradesh 3.00 3.00 3.00 3.00 12.00
Assam3.00 3.00 3.00   9.00
Bihar2.00 2.00 2.00 0.00 6.00
Chattisgarh 3.00 3.00 3.00 3.00 12.00
Gujarat3.00 3.00 3.00 3.00 12.00
Haryana2.00 2.00 2.00 3.00 9.00
Himachal Pradesh 3.00 3.00 3.00 2.00 11.00
Jharkhand 3.00 3.00 3.00 2.00 11.00
Karnataka 3.00 3.00 3.00 3.00 12.00
Kerala3.00 3.00 3.00 0.00 9.00
Madhya Pradesh 3.00 3.00 3.00 3.00 12.00
Maharashtra 3.00 3.00 3.00 3.00 12.00
Odisha3.00 3.00 3.00 3.00 12.00
Punjab3.00 3.00 2.00 3.00 11.00
Rajasthan 3.00 3.00 3.00   9.00
Tamil Nadu 3.00 3.00 3.00 3.00 12.00
Telangana 3.00 3.00 3.00 1.00 10.00
Uttar Pradesh 0.00   3.00 2.00 5.00
Uttarakhand 3.00 3.00 3.00   9.00
Small States
Arunachal Pradesh       0.00 0.00
Goa3.00 3.00 3.00 3.00 12.00
Manipur        0.00
Meghalaya 3.00 3.00 3.00 2.00 11.00
Mizoram3.00 3.00 3.00 2.00 11.00
Nagaland      1.00 1.00
Sikkim3.00 3.00 3.00 3.00 12.00
Tripura3.00 3.00 3.00 3.00 12.00
UTs
Andaman & Nicobar 3.00 3.00 3.00 3.00 12.00
Chandigarh 3.00 3.00 3.00 3.00 12.00
D & N Haveli & Daman
& Diu
3.00 3.00 3.00 3.00 12.00
Delhi3.00 3.00 3.00 3.00 12.00
Jammu & Kashmir 1.00 2.00 2.00 2.00 7.00
Ladakh3.00 3.00 3.00 0.00 9.00
Lakshadweep 3.00 3.00 3.00 3.00 12.00
Puducherry 3.00 1.00 3.00 1.00 8.00
Score: < 25% : 0 25%-50% : 1 50%-75% : 2 > 75% : 3
130
Annexures Service delivery essentials, Health
   
% of sub
centres
functional
% of CHCs
functional
% of
HWCs
functional
1.1: Infrastruc-
ture
% of ANM
posts
filled
1.2:
Human
Resource
Domain
1: Service
delivery
essentials
  Max value 3 3 3 9 3 3 12
Large
States
Andhra Pradesh3.00 3.00 3.00 9.00 3.00 3.00 12.00
Assam 3.00 3.00 2.00 8.00 3.00 3.00 11.00
Bihar 2.00 1.00 1.00 4.00 2.00 2.00 6.00
Chattisgarh 3.00 3.00 2.00 8.00 3.00 3.00 11.00
Gujarat 3.00 3.00 3.00 9.00 3.00 3.00 12.00
Haryana 3.00 3.00 1.00 7.00 3.00 3.00 10.00
Himachal Pradesh3.00 3.00 1.00 7.00 2.00 2.00 9.00
Jharkhand 3.00 3.00 2.00 8.00 3.00 3.00 11.00
Karnataka 3.00 3.00 3.00 9.00 3.00 3.00 12.00
Kerala 3.00 3.00 3.00 9.00 3.00 3.00 12.00
Madhya Pradesh3.00 3.00 1.00 7.00 3.00 3.00 10.00
Maharashtra 3.00 3.00 1.00 7.00 3.00 3.00 10.00
Odisha 3.00 3.00 2.00 8.00 3.00 3.00 11.00
Punjab 3.00 3.00 3.00 9.00     9.00
Rajasthan 3.00 3.00 1.00 7.00 3.00 3.00 10.00
Tamil Nadu 3.00 3.00 1.00 7.00 3.00 3.00 10.00
Telangana 3.00 3.00 2.00 8.00 3.00 3.00 11.00
Uttar Pradesh 3.00 3.00 1.00 7.00 2.00 2.00 9.00
Uttarakhand 3.00 3.00 1.00 7.00 3.00 3.00 10.00
Small
States
Arunachal Pradesh2.00 3.00 1.00 6.00 3.00 3.00 9.00
Goa3.00 3.00 3.00 9.00 3.00 3.00 12.00
Manipur 3.00 3.00 1.00 7.00 3.00 3.00 10.00
Meghalaya 3.00 3.00 2.00 8.00 3.00 3.00 11.00
Mizoram       0.00     0.00
Nagaland 3.00 2.00 3.00 8.00 3.00 3.00 11.00
Sikkim 3.00 3.00 2.00 8.00 3.00 3.00 11.00
Tripura 3.00 3.00 2.00 8.00 2.00 2.00 10.00
UTs
Andaman &
Nicobar
3.00 3.00 2.00 8.00 3.00 3.00 11.00
Chandigarh   3.00 3.00 6.00 3.00 3.00 9.00
D & N Haveli &
Daman & Diu
3.00 3.00 3.00 9.00 3.00 3.00 12.00
Delhi 3.00 3.00   6.00 3.00 3.00 9.00
Jammu & Kashmir3.00 3.00 2.00 8.00 3.00 3.00 11.00
Ladakh 3.00 3.00 1.00 7.00 3.00 3.00 10.00
Lakshadweep 2.00 3.00 3.00 8.00 3.00 3.00 11.00
Puducherry 3.00 3.00 1.00 7.00 3.00 3.00 10.00
Score: < 25% : 0 25%-50% : 1 50%-75% : 2 > 75% : 3
Annexures
131 Programme activities and intervention coverage, Health
 
 
% of newborn breastfed within one
hour of birth
% of children (12-23 mo) fully
immunized
% of children (6-59 mo) provided at
least 8-10 doses of IFA syrup
% of pregnant women who registered
for ANC in the first trimester
% of pregnant women who received
4 or more ANCs
% of pregnant women who were
given 180 IFA tablets Mar 2020
% of lactating women who were
given 180 IFA tablets
% of 5-9 years children who were
given weekly IFA tablets
% of pregnant women given TT2/
booster in Mar 2020
% of pregnant women given 1
Albendazole tablet after first trimes
% of children (0-59 mo) diarrhoea
cases reported treated with ORS
% of home visits to household with
pregnant mothers to counsel on
practices during pregnancy
2.1: Program activities
Has IFA been included in the EDL?
Has the State procured digital
invasive hemoglobinometers?
2.2_AMB strategy
Domain 2: Program activities and
intervention coverage
 
Max value
3
3
3
3
3
3
3
3
3
3
3
3
36
1
1
2
38
 
Score:
< 25%
: 0

25%- 50%
: 1

50%- 75%
: 2

> 75%
: 3
< 25%
: 0

25%- 50%
: 1

50%- 75%
: 2

> 75%
: 3
< 25%
: 0

25%- 50%
: 1

50%- 75%
: 2

> 75%
: 3
< 25%
: 0

25%- 50%
: 1

50%- 75%
: 2

> 75%
: 3
< 25%
: 0

25%- 50%
: 1

50%- 75%
: 2

> 75%
: 3
< 25%
: 0

25%- 50%
: 1

50%- 75%
: 2

> 75%
: 3
< 25%
: 0

25%- 50%
: 1

50%- 75%
: 2

> 75%
: 3
< 25%
: 0

25%- 50%
: 1

50%- 75%
: 2

> 75%
: 3
< 25%
: 0

25%- 50%
: 1

50%- 75%
: 2

> 75%
: 3
< 25%
: 0

25%- 50%
: 1

50%- 75%
: 2

> 75%
: 3
< 25%
: 0

25%- 50%
: 1

50%- 75%
: 2

> 75%
: 3
< 25%
: 0

25%-
50% : 1

50%-
75% : 2

> 75%
: 3
 
Yet to begin
: 0

In
process
: 0.5

Com
-
pleted: 1
Yet to begin
: 0

In process
: 0.5

Completed:
1
 
 
Large States
Andhra Pradesh
3.00
3.00
0.00
3.00
3.00
3.00
2.00
1.00
3.00
1.00
3.00
1.00
26.00
1.00
1.00
2.00
28.00
Assam
3.00
3.00
1.00
3.00
3.00
3.00
3.00
0.00
3.00
2.00
3.00
2.00
29.00
1.00
0.50
1.50
30.50
Bihar
3.00
0.00
0.00
2.00
2.00
3.00
1.00
0.00
3.00
1.00
 
 
15.00
1.00
0.50
1.50
16.50
Chattisgarh
3.00
0.00
0.00
3.00
3.00
3.00
2.00
0.00
3.00
3.00
3.00
3.00
26.00
1.00
0.50
1.50
27.50
Gujarat
3.00
0.00
0.00
3.00
3.00
3.00
0.00
3.00
3.00
3.00
3.00
 
24.00
1.00
0.50
1.50
25.50
Haryana
3.00
3.00
2.00
3.00
2.00
3.00
1.00
0.00
3.00
2.00
3.00
3.00
28.00
1.00
1.00
2.00
30.00
Himachal Pradesh
3.00
3.00
3.00
3.00
2.00
3.00
 
3.00
3.00
2.00
3.00
2.00
30.00
1.00
0.50
1.50
31.50
Jharkhand
3.00
3.00
0.00
2.00
3.00
3.00
3.00
0.00
3.00
1.00
1.00
3.00
25.00
1.00
0.50
1.50
26.50
Karnataka
3.00
3.00
0.00
3.00
3.00
3.00
3.00
 
3.00
2.00
3.00
2.00
28.00
1.00
0.00
1.00
29.00
132
Annexures Kerala
3.00
0.00
0.00
3.00
3.00
3.00
0.00
 
2.00
0.00
0.00
 
14.00
1.00
1.00
2.00
16.00
Madhya Pradesh
3.00
3.00
0.00
2.00
3.00
3.00
3.00
2.00
3.00
2.00
3.00
0.00
27.00
1.00
0.50
1.50
28.50
Maharashtra
3.00
3.00
1.00
3.00
3.00
3.00
2.00
1.00
3.00
2.00
3.00
3.00
30.00
1.00
1.00
2.00
32.00
Odisha
3.00
 
1.00
3.00
3.00
3.00
3.00
1.00
3.00
3.00
3.00
3.00
29.00
1.00
1.00
2.00
31.00
Punjab
3.00
1.00
0.00
0.00
0.00
0.00
0.00
 
0.00
0.00
3.00
3.00
10.00
0.50
0.50
1.00
11.00
Rajasthan
0.00
 
0.00
2.00
2.00
1.00
3.00
 
3.00
2.00
3.00
 
16.00
0.50
0.50
1.00
17.00
Tamil Nadu
2.00
0.00
0.00
3.00
3.00
3.00
0.00
2.00
3.00
1.00
3.00
3.00
23.00
1.00
0.50
1.50
24.50
Telangana
3.00
3.00
2.00
2.00
2.00
3.00
2.00
2.00
3.00
1.00
3.00
3.00
29.00
1.00
1.00
2.00
31.00
Uttar Pradesh
3.00
3.00
0.00
2.00
3.00
3.00
3.00
0.00
3.00
1.00
3.00
 
24.00
1.00
0.50
1.50
25.50
Uttarakhand
3.00
3.00
0.00
2.00
2.00
3.00
2.00
3.00
3.00
0.00
1.00
3.00
25.00
1.00
0.50
1.50
26.50
Small States
Arunachal Pradesh
3.00
0.00
0.00
1.00
1.00
2.00
1.00
0.00
2.00
0.00
 
0.00
10.00
1.00
0.50
1.50
11.50
Goa
3.00
 
0.00
2.00
3.00
2.00
3.00
 
1.00
1.00
3.00
 
18.00
1.00
1.00
2.00
20.00
Manipur
3.00
1.00
0.00
2.00
2.00
1.00
1.00
 
2.00
0.00
1.00
 
13.00
0.50
0.50
1.00
14.00
Meghalaya
3.00
3.00
0.00
1.00
1.00
1.00
0.00
 
2.00
0.00
0.00
 
11.00
1.00
0.50
1.50
12.50
Mizoram
 
 
 
 
 
 
 
 
 
 
 
 
0.00
 
 
0.00
0.00
Nagaland
2.00
0.00
0.00
1.00
0.00
1.00
0.00
0.00
1.00
0.00
 
 
5.00
1.00
1.00
2.00
7.00
Sikkim
2.00
2.00
3.00
3.00
2.00
2.00
3.00
0.00
3.00
1.00
0.00
3.00
24.00
1.00
0.50
1.50
25.50
Tripura
3.00
3.00
0.00
0.00
0.00
0.00
0.00
3.00
0.00
0.00
 
3.00
12.00
1.00
0.50
1.50
13.50
UTs
Andaman & Nicobar
3.00
3.00
1.00
2.00
3.00
2.00
1.00
2.00
3.00
2.00
0.00
3.00
25.00
1.00
0.00
1.00
26.00
Chandigarh
3.00
0.00
0.00
2.00
3.00
3.00
3.00
3.00
3.00
2.00
 
 
22.00
0.50
0.50
1.00
23.00
D & N Haveli & Daman & Diu
3.00
3.00
1.00
3.00
3.00
3.00
0.00
0.00
3.00
3.00
2.00
3.00
27.00
1.00
0.00
1.00
28.00
Delhi
2.00
0.00
 
2.00
3.00
3.00
1.00
 
1.00
1.00
 
1.00
14.00
1.00
0.50
1.50
15.50
Jammu & Kashmir
3.00
3.00
0.00
2.00
3.00
2.00
3.00
0.00
2.00
0.00
1.00
3.00
22.00
1.00
0.50
1.50
23.50
Ladakh
0.00
3.00
0.00
2.00
2.00
3.00
3.00
0.00
2.00
0.00
2.00
2.00
19.00
0.50
0.50
1.00
20.00
Lakshadweep
3.00
0.00
0.00
2.00
3.00
3.00
 
 
2.00
1.00
 
 
14.00
0.50
0.50
1.00
15.00
Puducherry
0.00
0.00
3.00
1.00
2.00
3.00
0.00
3.00
1.00
3.00
0.00
3.00
19.00
0.50
1.00
1.50
20.50
Annexures
133 ANNEXURE 4: POSHAN ABHIYAAN II MONITORING REPORT: DATA
COLLECTION FORM FOR MOWCD
S.No.
INFORMATION REQUIRED
[May share Annexures, Figures or %
wherever available]
RESPONSE
1 Details on Flexi-Funds (till 31st March,2020):
a. State/UT wise utilization of Flexi-funds
(in lakhs)
₹ 6067.84 (Details are annexed at
Annexure 4-A)
b. Any innovative aspect taken for utilising
Flexi Fund
2. Convergent activities undertaken by
MoWCD jointly by other Line Ministries
and Departments for supporting POSHAN
Abhiyaan (till 31st March,2020)
Details are annexed at Annexure 4-B
(As reported by Partnering Ministries
and Departments)
3. Details on supplementary nutrition: (till 31st March,2020)
a. State-wise information on the type and
content of Supplementary Nutrition as
THR and Hot- cooked Meal
Details are annexed at Annexure 4-D
b. State-wise information on the fortified
Supplementary Nutrition (THR and Hot-
cooked Meal) provided under ICDS
Details are annexed at Annexure 4-D
c. Information on the proportion of
malnourished children who received
increased rations under SNP rules
14,23,136
(Details are annexed at Annexure 4-E)
d. Any other (specify)
4. Best practices/Innovations made by
MoWCD, especially during COVID-19 times
that can be scaled-up for strengthening
Nutritional indicators in all States/UTs (Give
State specific details)
Details are annexed at Annexure 4-C
(Best practices/Innovations along with
DO letter issued to all States/UTs by this
Ministry)
5. Challenges faced (if any): !Manpower Shortages- vacancies at
various levels
!Training and capacity building of
field functionaries
!Slow roll-out of ICDS-CAS and
procurement of GMDs
!Sustaining “Jan Andolan” activities
!Enhanced Engagement with elected
representatives
!Multiple IT Platforms
!Low and delayed utilization of funds
!Convergence essential for expanding
!Shortage of Anganwadi buildings,
toilets and drinking water facilities
134
Annexures 6. State/UT wise Details on POSHAN Maah 2020 :
!No. of participants3,65,95,20,157
!No. of events 13,90,00,170
!No. of SAM children identified Not available
!No. of SAM children referred Not available
!Other details of the event Need to be specified
Annexures
135 ANNEXURE 4-A
Flexi-Funds
S.No.State/UTs
Flexi Fund
approved
by SLSC
committee
Status of im-
plementation/
funds ear-
marked (Rs. in
lakh)
Funds
Utilised
(Rs. in
Lakh)
Activities
1 A&N Islands Yes Implementation
Initiated
(Rs.26.88)
Rs.18.92 !Organizing Suposhan
Diwas once in a
month during the
month of February &
March, 2020–nukkad
natak, healthy baby
showers, cooking
champs etc.
!Celebration of Bal
Sabha‟ in all AWC-
Awards, Prizes,
refreshments
!Diploma course on
Nutrition at IGNOU
– Capacity Building
of AWC/Mukhya
Sevikas.
2 Andhra
Pradesh
Yes Implementation
Initiated
(Rs.650.54)
Rs.408.84 !ICDS Workshop
!Anganwadi Level
Monitoring Support
Committee
!Printing of IEC
Materials
!Printing of Sri Mitra
Books
!Sub-Centre Level
Meeting
!Multi-Sectoral CAP
!Improving Health
and Nutrition Status
(Tribal Areas) “100
Days Care” IEC
Material
!Need based modules
(ILA- Sectoral Level)
!Growth Monitoring
Slip Books
!Project Management
Expense
!IEC video films
136
Annexures S.No.State/UTs
Flexi Fund
approved
by SLSC
committee
Status of im-
plementation/
funds ear-
marked (Rs. in
lakh)
Funds
Utilised
(Rs. in
Lakh)
Activities
3 Arunachal
Pradesh
Under
process
Proposal
received
Rs.4.47 !14.2 kg cylinder
security deposit &
other charges for 778
LPG connection
!Gas Stove-778
!Refilling quarterly
in a year @appox
Rs.900 X 4 cylinders
4 AssamYes Implementation
Initiated
(Rs.1264.34)
Rs.8.32 !Digital Media
Campaign
!Capacity Building
of State, District &
Block Officials
!Pico Projector
!Learning Corner
Development
!Solar Kit
!Digital Platform
5 BiharYes Implementation
Initiated
(Rs.1159.07)
Rs.669.78 !Refresher Training of
AWW on ICT-RTM
!Refresher Training of
LS on ICT-RTM
!Gap Training
Orientation of Master
trainers
!Solar Fan/Light
System at AWC
!Configuration cost of
smart phone
!LCD display monitor
with battery and
inverter to AWC
!BALA (Building as a
learning aid)
6 Chandigarh Yes Implementation
Initiated
(Rs.46.21)
Rs.46.21 !Stainless Utensils
!Water Purifiers
7 Chhattisgarh Yes Under Process ——
Annexures
137 S.No.State/UTs
Flexi Fund
approved
by SLSC
committee
Status of im-
plementation/
funds ear-
marked (Rs. in
lakh)
Funds
Utilised
(Rs. in
Lakh)
Activities
8 Dadra &
Nagar Haveli
Yes Implementation
Initiated (22.1)
Rs.10.85 !Procurement of
ECCE Material
!Training and Capacity
Building of AWW
(Physical and Motor
skill development,
Language
development,
listening skill,
Speaking skill,
Reading preparation,
Word wall, Teaching
learning materials,
stories etc.)
9 Daman and
Diu
Yes Implementation
Initiated
(Rs. 13.83)
Rs.3.00 !ECCE Material-Tool
Kit
10 DelhiYes Under Process
(Rs.300)
Rs.29.29 !Incentives to AWWs
and AWHs for
improving nutritional
status of stunted and
wasted children
11GoaNo Proposal yet to
be received
——
12 Gujarat Yes Implementation
Initiated
(Rs.1439.02)
Rs.755.88 !Children Nutrition
Park at “Statue of
Unity” at Kevadiya
Colony
!Setting up of State
Management Centre
(SMC)
!State level meetings,
workshops and
training
!ICDS CAS Dashboard
training
!e-ILA orientation and
certificate printing
!ILA refresher training
!Strengthening of
District and Help
desk team of
POSHAN Abhiyaan
138
Annexures S.No.State/UTs
Flexi Fund
approved
by SLSC
committee
Status of im-
plementation/
funds ear-
marked (Rs. in
lakh)
Funds
Utilised
(Rs. in
Lakh)
Activities
!Supportive
supervision of
POSHAN Abhiyaan
components
!Strengthening
of Financial
Management system
at State
13 Haryana Yes Implementation
Initiated
(Rs.333)
Rs.24.00 !Kitchen Gardening
(Rs.1.89 core)
!Strengthening
of monitoring
mechanism at Block
Level & District Level
(Rs.1.44 crore)
14 Himachal
Pradesh
Yes Implementation
Initiated
Rs.231.02 !Swachhta Kit @ 1146
per AWC/ Mini AWC
15 Jammu and
Kashmir
No
Proposal yet to
be received
——
16 Jharkhand Yes Under Process
—
!Mobile based
application
for supportive
supervision
!Printing of e-ILA
certificates.
17 Karnataka Yes Under Process
(Rs.1151.34)
Rs.117.62 !Strengthening of
CDPO offices
!Strengthening of DD
offices
!Orientation of
Balvikas Samithies
18 Kerala Yes Implementation
Initiated
(Rs.501)
Rs.150.82 !Setting up of DPMUs
& Expenses
!Setting up of BPMUs
!Smartphones and
Data Plan to AWW
and operating Staff
!Mobile Configuration
& MT CAS Training
19 Ladakh No———
Annexures
139 S.No.State/UTs
Flexi Fund
approved
by SLSC
committee
Status of im-
plementation/
funds ear-
marked (Rs. in
lakh)
Funds
Utilised
(Rs. in
Lakh)
Activities
20Lakshadweep Yes Implementation
Initiated
(Rs.22.79)
Rs.4.30 !Poshan Maah 2018-19
(Rs.4.3 Lakh)
!Printing traditional
culinary art book
(Rs.5.5 Lakh)
21 Madhya
Pradesh
Yes Implementation
Initiated
(Rs.2605.17)
Rs.250.31 !“Angan” Nutrition
Care Centre Angan–
Camp to established
community-based
management of
severe underweight
children
!Electricity Facility
through Solar Panel
at AWC
!Poshan Sakhi: This
proposal aimed to
utilize the second-
best opportunity in
life to prevent and
prevent malnutrition
and anaemia.
22 Maharashtra Yes Implementation
Initiated
(Rs.1811.12)
Rs.608.24 !Sensitization
of elected
representatives of
PRIs and Urban local
bodies
!Joint workshops
of health & ICDS
to promote
behaviour change
communication
!Training of
Supervisors
on supervisor
Application of CAS
!Induction-cum-
training of State,
District, and Block-
Helpdesk staff
!Training of State,
District officials
and CDPOs on
Dashboard
140
Annexures S.No.State/UTs
Flexi Fund
approved
by SLSC
committee
Status of im-
plementation/
funds ear-
marked (Rs. in
lakh)
Funds
Utilised
(Rs. in
Lakh)
Activities
!Review Meeting of
District and Block
level help desk
!Travel cost of ICDS
officials (JPCs and
Nodal officer) to
Delhi/ other lo cation
for GOI meetings
!Quick research study
on cultural no rms
to understand the
factors inhibiting
behaviour change
communication in
order to achieve the
goals of POSHAN
Abhiyaan. The State
is going to sign
MoU with T.H. Chan
Research Center,
Mumbai under
Harvard University
23 Manipur Yes Under Process
(Rs.61.6)
Under
process
!Plan for slogan,
essay and drawing
competition on safe
drinking water/
healthy eating habits
!Promoting Nutri
Garden in 16
POSHAN Abhiyaan
Districts
!Provision of
electricity to 500
pucca AWC @
Rs.5,000/- per AWC
24 Meghalaya Yes Implementation
Initiated
Rs.150.24 !Printing of Flip
Books: 6170 nos.
!Printing of takeaways
Annexures
141 S.No.State/UTs
Flexi Fund
approved
by SLSC
committee
Status of im-
plementation/
funds ear-
marked (Rs. in
lakh)
Funds
Utilised
(Rs. in
Lakh)
Activities
25 Mizoram Yes Implementation
I nitiated
(Rs.88.5 6)
Rs.88.56 !POSHAN related
travel expenses.
Specially for the
District and Block
staff recruited under
POSHAN Abhiyaan
!Expenses at ILA
training at sectoral
levels and other
miscellaneous
POSHAN activity-
related Expenses
!District and Block
IT infrastructure and
equipment
26 Nagaland Yes Implementation
Initiated
Rs.213.55 !One Time Grant to
AWC for CBE
!Purchase of
Smokeless Chullas
for Peren Districts
!Establishment of 22
Nutri-Gardens
!ILA Takeaways for
21 Modules (25
Takeaways)
!ICDS-CAS Training
for AWWs, LS, DPOs,
CDPOs & State
Officials
27 Odisha————
28 Puducherry Yes Implementation
I nitiated (10.95)
Rs.8.50 !Configuration of
Mobile Devices
!Printing of Takeaways
to the AWW
!ICDS-CAS Training to
AWW
!Painting of AWC
with the POSHAN
Abhiyaan themes
!Provision of I.D.
Cards to AWWs
29 Punjab Yes Under Process
(Rs.292.4)
Under
Process
!Upgradation of AWC
to Model AWC
142
Annexures S.No.State/UTs
Flexi Fund
approved
by SLSC
committee
Status of im-
plementation/
funds ear-
marked (Rs. in
lakh)
Funds
Utilised
(Rs. in
Lakh)
Activities
30 Rajasthan Yes Implementation
Initiated
(Rs. 1288.21)
Rs.246.92 !Configuration of
Smartphones & ICT-
RTM (LS & AWWs)
!Refresher Training on
CAS & ILA
!Strengthening of
CDPO offices
!Strengthening of DDs
Offices
!Web Based
Monitoring
Information System
!Printing of Monthly
Single Register
!Maintenance &
Repair/AMC (Growth
Monitoring Devices)
!Orientation
Workshops
!Orientation of PRIs
!Exposure/Study
Visit/Review
Monitoring
31 Sikkim Yes Implementation
Initiated
(Rs 49.98)
Rs.49.98 !Celebration of
3rd Anniversary
of Launching of
POSHAN Abhiyaan
!POSHAN Phagwada
!Provision of VC Lab
at SPMU
!World Breast
Feeding Week
!International Yoga
Day
!World Health Day
!Village Health
Sanitation and
Nutrition Day
Annexures
143 S.No.State/UTs
Flexi Fund
approved
by SLSC
committee
Status of im-
plementation/
funds ear-
marked (Rs. in
lakh)
Funds
Utilised
(Rs. in
Lakh)
Activities
32 Tamil Nadu Yes Implementation
Initiated
(Rs.516.95)
Rs.248.73 !Electricity to 220
AWC
!Printing and Supply
of Handbook on
Growth Monitoring
Devices
!Printing and supply
of guidelines in Tamil
language
!Expenditure on
convening the
Convergence Plan
Committee meeting
at State/Districts/
Blocks
!Procurement of LCD
Projector for 32
Districts
!Imparting orientation,
induction &
sensitization training
!Promoting Kitchen
Garden in 655 AWC
!Six-seater table chair
kit
!Mobile configuration
& preparation of
devices training to
Help Desk Personnel
(Phase I & II Districts)
33 Telangana ————
34 Tripura Under
process
Proposal
received
——
35 Uttar
Pradesh
Yes Implementation
initiated (Rs. 20
42.03)
Rs.1401.97 !Suposhan Swasth
Mela
!Flip Book
36 Uttarakhand Yes Implementation
initiated
(Rs.697.12)
Rs. 317.52 !Hydroponic Farming
!Solar Cooker
!Recipe Book
37 West Bengal No Proposal yet to
be received
——
TotalRs.6067.84
144
Annexures ANNEXURE 4-B
Convergence activities undertaken by partner Ministries/
Departments under POSHAN Abhiyaan
S. No. MinistryActivity
1. Ministry of Youth
Affairs & Sports
Dept. of Sports
!The Department supports and encourages balance and
nutritious diet for a good health.
!The Department has launched Fit India Movement in August,
2019, which cover all aspects having a bearing on fitness and
healthy living viz., physical fitness, mental fitness, healthy life
style, preventive health care, sustainable and environment
friendly living, etc. including healthy eating habits, healthy
and balance diet.
!The Department has rationalized the diet and food supplement
charges under which financial assistance towards diet, food
supplements are provided to all athletes whether Senior,
Junior or Sub Junior athletes. Earlier Senior, Junior athletes
and SAI trainees had different diets which has been done
away with to ensure parity amongst all level of trainees.
2. Ministry of Health &
Family Welfare
!Intensified Mission Indradhanush 2.0 was launched in
December 2019 and 4 rounds were conducted from
December 2019 to March 2020. During these rounds about
37.09 lakh children and 7.41 lakh pregnant women were
vaccinated.
!Pneumococcal Conjugate Vaccine (PCV) vaccination is in 6
States-HP, Bihar, MP, Rajasthan, UP, and Haryana. Introduced
PCV on its own. In last 6 months:
PCV expanded to 17 Districts of Rajasthan, to cover entire
State.
Expansion in UP to remaining 56 Districts started. Already
covering 19 Districts.
More than 49 lakh doses administered from January 2020
to April 2020
!Rotavirus vaccine (RVV) has already been expanded to the
entire country, by September 2019. More than 1.8 crore doses
administered from January 2020 to April 2020.
!National Deworming Day (NDD) was conducted in 25 States/
UTs11.3 Cr children were covered with average 94% coverage
as per the target set by States and UTs
!Under Home Based Newborn Care (HBNC) programme
46.92 lakhs newborns received complete schedule of home
visits by ASHA. 2.5 lakhs sick newborns referred to health
facilities
!Under Home Based Care for Young Child (HBYC) programme:
Out of 242 Districts, 238 Districts have completed trainers
training
Annexures
145 S. No. MinistryActivity
1,60,339 frontline workers are trained covering 179
Districts across 27 States/UTs
1,83,975 children received scheduled visits in 39 Districts
(including 22 Aspirational Districts) from 11 States/UTs.
!Institutional Deliveries: 94% deliveries reported in the
hospitals against total number of reported deliveries. (i.e.
1.97 crore deliveries conducted in hospital out of total 2.08
crore deliveries reported); 70% of delivery reported in public
health facilities.
!LBW: 12.6% of the newborn were reported as LBW as per
HMIS
!Antenatal Check-up: 71% ANC registered in the 1sty trimester;
80% PW received 4 or more ANC check-ups
!IFA supplementation: 91% PW given 180 IFA tablets.
!Community and Home distribution of IFA supplementation
from Jan-May’ 20 through community and home distribution:
6-59 months- 1.62 Cr; 5-9 years: 1.38 Cr; 10-19 years: 1.83 Cr
!Vitamin-A supplementation: 69.83 lakhs children were
provided with 1st dose of vitamin-A supplementation
!RBSK: As reported by State/UTs in Q-4 of January 2020 to
March 2020:
!0-3 years’ children: 1.2 crores were screened; 5.95 lakhs
children were identified with any of 4Ds including 18,607
defects at birth, 32,144 developmental delays, 1.9 lakhs
Deficiency and 3.54 lakhs diseases; 3.16 lakhs children availed
services at secondary tertiary care institute
!4-6 years’ children: 1.07 crores were screened; 9.21 lakhs
children were identified with any of 4Ds including 12,034
defects at birth, 51,721 developmental delays, 2.5 lakhs
Deficiency and 6.07 lakhs diseases
!4.91 lakhs children availed services at secondary tertiary care
institute
States/UTs.
States/UTs have been requested to operationalize the
blending of fortified rice and its distribution through PDS as
early as possible. So far
!15 State Governments i.e. Andhra Pradesh, Kerala, Karnataka,
Maharashtra, Odisha, Gujarat, Uttar Pradesh, Assam, Tamil
Nadu, Telangana, Punjab, Chhattisgarh, Jharkhand, Madhya
Pradesh & Uttarakhand have consented for implementation
of the Pilot Scheme.
!Out of these 15 States, Maharashtra (from Feb. 2020),
Gujarat (from Feb. 2020) & Andhra Pradesh (from April
2020) have started distributing of fortified rice under the
Pilot Scheme.
146
Annexures S. No. MinistryActivity
!Targeted Public Distribution System (TPDS)/National Food
Security Act, 2013 (NFSA): Covers all States & UTs; Poorest
of poor entitled 35 kg foodgrains per family per month;
priority household entitled to 5 kg foodgrains per person
per month at uniform subsidized price Rs. 3/2/1 per kg for
rice/wheat/coarse grains respectively.
!Special provisions for pregnant women, lactating mothers
and children aged 6 months-14 years entitled to free
nutritious meal through ICDS network and MDMS.
!Higher nutritional norms have been prescribed for
malnourished children up to 6 years of age.
!Pregnant women and lactating mothers are entitled to
receive cash maternity benefit of Rs. 6,000 for the wage
loss during the period
5. Ministry of Jal
Shakti
Dept. of Drinking
Water & Sanitation
Provision for providing safe drinking water in adequate
quantity of prescribed quality to public institutions such
as Gram Panchayat buildings, schools, AWC, health centres
through functional household tap connection under “Jal
Jeevan Mission”.
6. National Service
Scheme
!Poster making competition on nutritional values
!Seminars and workshops on poshan and its benefits
!Wall paintings in public places on theme of poshan/nutrition
!Nukkad Nataks, Rallies and door-to-door campaign in NSS
adopted villages/slums on importance of nutrition, girl
education, hygiene and sanitation, Anaemia, etc.
!Classroom lectures on adolescent healthy diet
!Awareness sessions on eating disorder, lack of physical
activity, malnutrition, obesity, impact of fast food/soft drink/
packaged food, importance of balanced diet
!Activities: 587 activities undertaken
!Volunteers: 1,56,101 volunteers were involved
!Participation: 1,74,532 beneficiaries participated
7. Nehru Yuva Kendra
Sangathan
!Display of banners and other publicity material highlighting
core issues of poshan covering 9,354 villages
!3,565 meetings were held with eminent citizens to sensitize
the villagers about importance of poshan
!369 gosthi, lectures and discussions were conducted by
eminent resource persons on focus areas of poshan.
!Door to door campaign in 289 villages focusing on general
cleanliness & hygiene, prevention of anaemia, regular de-
worming methods, Say No to Tobacco use, alcohol & drugs
and maintenance & adequate sanitation facilities in the village
!Distribution of IEC material on Poshan Maah in 289 villages.
Total 1,368 activities which included Rallies, Run, Pad Yatra,
Cycle Yatra,
!Cultural Programmes, Nukkad Nataks, Short Film Shows,
Exhibitions, Competitions were conducted to focus public
attention on focus areas of Poshan Maah
Annexures
147 S. No. MinistryActivity
8. Dpt. of School
Education &
Literacy
!Developed cadre of 3,20,373 Poshan Monitors
!7,40,045 Poshan Report cards prepared
9. Dept. of
Agriculture,
Cooperation
& Farmers’
Welfare, Ministry
of Agriculture &
Farmers Welfare
!Nutri-cereals comprising Jowar, Bajra, Ragi/Mandua, Kutki,
Kodo, Sawa/Jhangora, Kangni/Kakun and Cheena have been
implemented in the National Food Security Mission since
2018-19 in 202 Districts of 14 States.
!Promotion of nutri-cereals through Kisan Goshthis, training
at KVK level, SAU and State Agriculture Dept. Provision of
safe grain storage.
!Other interventions include cluster front line demonstrations,
creation of seed hubs, distribution of seed kits, print &
electronic publicity, etc.
!Establishment of three “Centres of Excellence‟ across the
country. Provision of setting up of processing units.
!Bio-fortified and high-yielding crop distribution through
seeds and FLD.
10.Ministry of Tribal
Affairs
!Evaluation undertaken on “Scheduled Tribe Component
Relevance and Effectiveness in GoI Funded Schemes‟ which
included POSHAN Abhiyaan, Anganwadi Services-ICDS,
PMMVY, NIPCCD, etc.
Department of Animal Husbandry & Dairying:
!“Eklavya Kamdhenu Project‟ envisions to establish
„Gaushalas‟ under “Rashtriya Kamedhenu Aayog” in EMRSs
with a view to provide Desi cow’s milk and milk products for
self-sustainability towards milk consumption among school
children to improve their nutritional status.
!In addition, community nutrition approaches in and around
the EMRS school will be used to further address dietary
diversity in tribal households.
11.Ministry of Minority
Affairs
!Interventions in the form of trainings, community mobilisation
or assisting States in creation of AWC.
12.Ministry of AYUSH !Generating nutrition awareness through Health and Nutrition
camps and lectures through its national institutes.
!The Ministry has also shared yoga protocol for pregnancy,
children and adolescent with MoWCD to incorporate it into
POSHAN Abhiyaan.
!The Ministry is actively participating in the Poshan Pakhwada
and Poshan Maah every year.
!Introduction of Yoga activities in schools in collaboration of
Department of School Education and Literacy, MHRD
!Introduction of poshan awareness in AYUSH Health and
Wellness Centres in collaboration with local AWC.
!Awareness programme for Herbal plants with high nutritional
value in AYUSH Health and Wellness Centres
148
Annexures S. No. MinistryActivity
13.Ministry of
Panchayati Raj
!Held special gram sabha with the participation from
community resource persons, ANMs, Sakhis etc for:
!Identification of pregnant women and local nutritional food
in GP area
!Discuss list of available supplementary foods in the
Anganwadi for disbursement to beneficiary
!Discuss subjects of education, safety, reproductive health,
equal opportunity
!Highlight the importance of sanitization, immunisation and
institutional delivery
!Undertaking of Poshan Jan Andolan
!Implementing the centrally sponsored scheme of RGSA to
strengthen PRIs through capacity building & training
14.Ministry of Rural
Development
!Provision of providing funds for convergence with MGNREGS
e.g. AWC buildings.
!Under the provision of MGNREGA, in case the number of
children below the age of five years accompanying the
women working at any site is five or more, provisions shall
be made to depute one of such women workers to look
after such children. The person so deputed shall be paid
wage rate.
!The most marginalized women in the locality, women in
exploitative conditions, or bonded labour or those vulnerable
to being trafficked or liberated manual scavengers should be
employed for providing child care services.
!Under the mandate of MGNREGA, the District Programme
Coordinator shall ensure that at least 60% of the works to
be taken up in a District in terms of cost shall be for creation
of productive assets directly linked to agriculture and allied
activities through development of land, water and trees.
!A convergence Framework for scientific planning and
execution of water management works with the use of
latest technology has been mandated in consultation with
an agreement of the MoJS and the MoAFW was issued
15.Ministry of New &
Renewable Energy
!Providing solar panel to Anganwari Kendras: MNRE Scheme
for off- grid solar PV Ph-III was closed on 31.3.2020 and now
available only for NE States.
16.Ministry of Housing
& Urban Affairs
!An advisory was issued to all the States/UTs requesting to
incorporate AWC in DPRs for In-Situ Slum Redevelopment
(ISSR) and Affordable Housing in Partnership (AHP) projects
wherever gaps exist.
!An advisory was issued to the States requesting to use
the allocated budget for ODF (IHHT, CT/PT, Urinal) under
Swachh Bharat Mission-Urban (SBM-U) for construction of
Toilets/Urinals in AWC situated within the jurisdiction of the
Municipal Corporations in their States/UTs.
Annexures
149 S. No. MinistryActivity
17.NITI Aayog !CSR funding in health & nutrition programmes: Mobilisation
of Rs.70.4 crore in 57 Aspirational Districts
!Involvement of PRI in Jan Andolan for nutrition: Training
modules have been developed and 1st ToT has been
conducted by NIRD, Hyderabad; Training roll-out in 25
Aspirational Districts covering 1 lakh members; 15,000
members sensitised on risk migration and COVID-19
awareness in 25 Aspirational Districts.
!Periodic surveys undertaken for monitoring progress of
POSHAN Abhiyaan in 25 Aspirational Districts
!Rice fortification to be undertaken by Dept. of Food & Public
Distribution in 15 Districts as a pilot programme.
!Biannual monitoring reports on POSHAN Abhiyaan and
quarterly monitoring reports on PMMVY
!Evaluation study conducted on strengthening of ICDS; draft
report with recommendations shared with MoWCD
!Promotion of healthy diets through local food systems
150
Annexures ANNEXURE 4-C
Best practices/innovations made by MoWCD, especially during COVID-19 times that
can be scaled-up for strengthening Nutritional indicators in all States/UTs, following
are the activities that have been undertaken by CD-Section during the COVID-19
pandemic
ÂRegarding initiatives taken by AWW in view of the COVID-19 outbreak, an
advisory DO letter dated 11th March, 2020 was issued to all States/UTs forwarding
therewith the tasks assigned to this Ministry regarding COVID-19 as under:
Facilitate utilization of AWW and Supervisors in surveillance and other
community level activities by MoH&FW.
Facilitate mobilization of SHGs to create awareness.
Proper sanitation at AWC and health education to children and their parents.
Further, AWW and Anganwadi Helpers are also actively involved in conducting other
activities during COVID-19 such as door to door survey, community surveillance, etc.
ÂRegarding functioning of AWC during the present circumstances, the distribution
of food items and nutrition support by AWWs, once in 15 days, at the doorstep
of beneficiaries – children, women and lactating mothers has been permitted
as per the guidelines issued by Ministry of Home Affairs. Regarding this, a letter
dated 16.04.2020 followed by a DO letter dated 19.05.2020 was issued to all
States/UTs by this Ministry.
ÂRegarding special initiatives taken under Anganwadi Services, it is stated that in
view of the special circumstances prevailing in the country due to the COVID-19
pandemic, the life cover for AWW/Anganwadi Helpers in the age group of 51-59
years (closed group as on 01.06.2017) has been increased from ₹ 30,000/- to ₹
2,00,000/- primarily for a period of three months i.e. upto 30.06.2020.Further,
POSHAN Abhiyaan was itself set up for improving the nutritional standards of
children in the country. Therefore, POSHAN Abhiyaan may also incorporate some
points in the point no. 4 mentioned as above.
Best practices shared by some of the States/UTs, can be scaled-up
for strengthening Nutritional indicators
1. Lakshadweep – Establishing Nutri-gardens in and around Anganwadi
Key highlights
ÂLakshadweep has 107 Anganwadi spread over 10 Islands. There is no COVID-19
case reported in entire UT, still the adverse effect of COVID-19 is on the supply
of green leafy vegetables/fruits can be seen.
ÂThe concept of Anganwadi Kitchen gardens was initiated in Lakshadweep, with
each Anganwadi adopting 15 houses. To initiate the same, UT’s main focus was
on Convergence of WCD, Agriculture, Rural Development & Village Panchayats.
Annexures
151
ÂIn March 2020, UT has started distributing the seeds. So far, 99 clusters
at UT level already initiated Anganwadi Kitchens. Each having 30 families i.e.
3000 households (besides 1600 around the AWC) benefitted. Lakshadweep
has targeted to cover 4600 households & 107 AWC with a budgetary provision
of around Rs.3200/- per target household. UT promotes organic foods from
last 15 years. Since the land is scarce, and sandy, so they grow in coconut
canopies – the Grow Bags.
ÂLakshadweep has aimed to feed all 65,000 population through this initiative,
and to actively initiate the same, 440 SHGs are involved in fruits and vegetables
promotion across the UT. To implement it effectively, 60 multi-skill employee
are trained in the field of Nutri-gardens who support all the so far formed
99 clusters. UT’s idea is to make the Nutri-garden profitable, so that peoples’
economic factors can be addressed across the UT. Vegetable exchange
programme has also been initiated by the UT.
2. Gujarat – Online tracking and adoption of severe underweight children
through Jan Bhagidari
Key highlights
ÂGujarat’s focus during Poshan Maah 2020 is Community Participation and
Ownership. State emphasized on key 5 points needed to address malnutrition–
First 1000 days; Anaemia, Diarrhoea, Sanitation and Complementary feeding
while banking on effective Convergence with 8 Departments.
ÂKey interventions undertaken by the State are namely EkBalak, EkPalak – which
is being initiated by the Chief Minister and followed by other officials, Mukhya
Mantra SuposhitGujatarNidhi–to improve the overall malnutrition scenario
of the State, andState Management Centres–to communicate with the Field
Functionaries and other stakeholders.
ÂKey results of such interventions includes–70,000 severe underweight children
adopted by PaalakWali (Guardians), Unique IDs of 1.08 lakh severe
underweight children have been created for follow up purpose, Phone calls
are being made for tracking of THR, monitoring of home visits made by AWWs
and getting feedback of Paalakwalis, Badges, certificates and guidelines
distributed to Paalakwalis to motivate them, and Communication established
through State Management Centre (SMC) .
ÂOther nutrition specific initiatives taken by the State includes– PuShTI
(Poshan Umbrella for supply chain through Tech-innovation) for ensuring
transparency, quality, efficiency and accountability in THR distribution. This has
also been recognized as a best practice by NITI AYOG. Promotion of anaemia
prevention in pregnant women and adolescent girls through the use of iron
utensils and promotion of Nutri garden. Also, 1870 low cost hand wash models
being installed at AWC and community places to improve hygiene practices
without wasting water.
152
Annexures 3. Odisha – Revamping Supplementary Nutrition Programme & Introduction
of Millets in SNP
Key highlights
ÂState has highlighted the decentralized model of supplies of SNP across
72,000 AWC, while focusing on the unaffected distribution of THR during the
recent floods. For this, the State has engaged 548 SHGs in THR production
and distribution i.e. for roasting, weighing, package and distribution of grains.
Additionally, the State has also formed ajaanch-committee at every AWC
which is responsible to promote transparency.
ÂState has also shared that they have made guidelines for financial engagement
of SHGs. Every 23rd of the month is dedicated for packaging and better
monitoring. This additionally streamlines end to end tracking of indents and
payments of online bills. Also, quality is the key factor monitored consistently
by the State. For this, IT interventions are focused to make the Supply Chain
robust. Geo-tagging, with pictures is an added feature of the same, which
works from production to distribution. State has mentioned that the system
has enhanced transparency, accountability, quality, monitoring, and thus the
improved nutrition status. Nutrition distribution is tracked at multi- level from
Field Functionaries to CDPO to SHG, while effectively engaging them all for
the jobs assigned to each one of them.
ÂState further has multi-sectoral plan and additional plans for hard to reach
areas. State’s adoption system for SAM and MAM is in place and the focus
is on complementary feeding for which fish-based food distribution is being
taken as a pilot. Creshes have also been initiated in several areas of the
State. Similarly, to reach out to the children who can’t reache the AWC, a
system is being formulated – AWC to pada. State has also distributed baby
furniture through District mineral funds
4. Uttarakhand – Adoption of SAM children by Government officials,
Public Representative and public
Key highlights
ÂUttarakhand has discussed on adoption of SAM by officials, public
representatives and public. State has further stated that Nutrition is
multi-disciplinary in the State, and it includes sanitation, hygiene etc. In
continuation to last year’s initiative by the Hon’ble Chief Minister, officials
were requested to adopt one child each which resulted in adoption of 9177
SAM/MAM children. Similarly, 1962 children freed from SAM/MAM category
and 385 children upgraded.
ÂThe schemes and efforts of government were made more reachable and
the concept of ‘Sarkar Aapke Dwar’ (Govt. at your doorstep) was actualized.
People were sensitized towards malnutrition and its ill effect on the growth
Annexures
153 and overall development of their children and were made aware of the totality
of the causes that can affect health of a family. Convergence helps addressing
the multi- dimensional problems of SAM and MAM. Under Flexi-fund the
State has promoted distribution of sprouted food. State has also launched
Sanjeevani Programme (on 3rd Sep, 2019) in which Rs.2,000 per month for
6 months given to each child. Under this programme, prescriptions from PHC,
along with the edibles are being distributed to target children.
5. DNH and D&D – Identification Drive for SAM Children
Key highlights
ÂD&NH and D&D are tribally dominated territories and has high prevalence of
malnutrition amongst children, as compared to national average. State shared
that during COVID-19 they have 100% coverage for THR and the consumption
issues are also being addressed. State has esp. engaged District Collectors
with the H&FW as a result of which 25,800 out of 28,000 children measured
during the said drive. This drive covers 4 steps namely– Growth Monitoring,
Screening (MOs/paediatricians), diet diversity, and counselling of all concerned.
ÂUT has also shared that the locally used ICD based systems is being developed
and functional. Micro-plan for each AWC to identify each SAM is in place.
They have prepared SoP of the same and trained the AWWs through nodal
officers. To create transparency, parents are also involved in the activity.
ÂIn the joint drive, H&FW takes upper arm circumference while WCD for height
& weight, finally, an MO looks after the same. Children then categorized on
the basis of complications for referral (to NRC) or no-referral. ICT based tool
is in place with H&FW to measure the impact of this programme.
154
Annexures ANNEXURE 4-D
Supplementary Nutrition Programme details from States/UT
S.No. States
Morning Snack (MS)/Hot
Cooked Meal (HCM)
Take-Home Ration
Fortified food
items used in SNP
1 A&N MS–Green gram whole,
egg, boiled groundnut
and milk. HCM–Khichdi,
rajma rice, rice kheer
Quantity–20-120gms + 1
egg per day
THR given in the form
of HCM
Fortified edible
oil used in SNP
for other items
action has been
initiated.
2 Andhra
Pradesh
Rice, Dal, Oil, Vegetables,
Eggs Curry, Boiled
Channa
Quantity–(3-6 y) Snacks
-15g.
HCM–95g, eggs–4 per
week
6m-3y & SAM Children
– Balamrutham
(Weaning Food), Egg
PW&LM–one full meal
consisting of dal,
rice, oil, milk, eggs &
veggies.
Double Fortified
Salt (DFS),
fortified oil,
rice (two pilot
Districts- West
godavari and
krishn) supplied
by Civil supplies
dept.
3 Arunachal
Pradesh
MS-biscuit/kheer/Instant
Poha 2 days each & HCM–
Rice-50gm, Dal-15gm,
oil-5 gm
Energy Food (Rice
& Pulse base)/
Quantity-100gm, PM
& LM-Instant poha &
Kheer-150
HCM–No, THR–
yes
4 Assam Khichdi, payas, suji halwa,
Quantity- 80g
6m -3 y- rice and
peas; SAM–rice and
mixed pulse-based
micronutrient fortified
energy dense food;
P W&LM–Rice and
mixed pulse-based
micronutrient fortified
energy dense food–110g
HCM–No, THR–
yes
5 Bihar MS-milk powder-18 g,
water-150ml & boiled egg
-1 pc & Germinated Chana
+jaggery-60gm once in a
week each & rice flake &
Jaggery-60g m four days
in a week,
Given in the form
of dry ration (food
grain)- Rice -2500gm,
Pulse-1250 gm,
soyabadi-500gm or
egg-8 pc/ month, SAM-
Rice-3750gm, masoor-
1750gm, egg-12/month
or soyabadi-875gm/
month, PW&LM-
Rice-3500gm, pulse-
1500gm, egg
-7 or soyabadi-450g/
month
DFS pilot in 6
Districts and plan
to cover entire
State in June
2019.
Annexures
155 S.No. States
Morning Snack (MS)/Hot
Cooked Meal (HCM)
Take-Home Ration
Fortified food
items used in SNP
HCM-Khichidi-Rice-60gm,
Pulse-25gm, Vegt-20 gm,
oil-5gm thrice in a week
& rice pulao–Rice-60gm,
chana-20gm, vegt-20gm,
oil-5gm once in a week
& Suji Halwa-Suji-60gm,
G.nut-10 gm, sugar-30gm.
oil-5gm once in a week
& Ra shiya-Rice-60gm,
Jaggery-30gm, G.nut-
10gm once in a week
6 Chandigarh Murmura, Halwa, Sweet
Dalia, Kadi Rice, Aloo
Nutri with gravy, Rice,
Khichadi, Ghiya Chana
dal, Aloo chana, Quantity-
60-200gms
6m-1 y in the form of
weaning foods , 1-3
years in the form of
cooked food , murmura
mixture, kadhi rice
sweet dalia, ghia chana
dal rice, halwa, aloo
chana black, khichdi,
moog dal and rice
kadhi chawl, nutri aloo
with gravy); SAM–HCM,
PW&LM–HCM
fortified food is
supplied in AWC
7 ChhattisgarhMS- RTE, poha,
HCM–Roti, rice, mixed
dal, sabzi, fortified oil,
achar, papad, salad,
jaggery, Quantity–approx.
120g-150g as per menu
THR in powder form Fortified oil and
salt
8 Dadar &
Nagar Haveli
Boiled Egg/ fruit,
Vegetable khichdi, Sheera,
S prouted moong and
ground nut, Sukhdi and
fruit, vegetable dalia,
sprouted channa, lapsi;
Quant ity- 100g–250 g
THR for 6 m to 3
years–under process,
currently HCM is
provide d similar to 3
-6 years, SAM–RUTF
, PW&LM–Dry Ration
(Rice, wheat, Jaggery,
Ground nut, Tuvar Dal,
Raosted sing chana, oil,
moong dal, moong)
DFS and oil are
used
156
Annexures S.No. States
Morning Snack (MS)/Hot
Cooked Meal (HCM)
Take-Home Ration
Fortified food
items used in SNP
9 Daman & Diu Veg khichdi, sukhdi +
boiled egg,, Boiled chana
+ banana, sujhdi+ boiled
moong, roasted peanut
chana+ lapsi, boiled
chana+ boiled egg, boiled
ground nut + banana),
Quantity- 30-60g
6m- 3y- Presently given
Hot cooked meal, SAM–
not mentioned, PW
& LM- Dry ration given
as THR (Wheat, Rice,
ground nut chikki, tuvar
dal, whole moong, desi
chana, ragi, DFS
DFS and fortified
oil with Vit A &
D used in the
recipes
10 Delhi Boiled Bengal gram and
green peas, sweet &
namkeen dalia, khichadi,
halwa, veg. pulao, kal
a chana, dal with rice;
Quantity–HCM–270g, M
S–50g
6m–3 y -Panjiri ,
Weaning Food, S
AM–not mentioned,
PW&LM- not
mentioned
no
11Goa Monday -Mix Laddu,
Tuesday Gram dal sweet,
Wednesday–Sweet Idli,
Thrusday- Green peas
usal, Friday–Ground nut
Chikki, Sat- Moong K
hichdi; Quantity- 82g-126g
6m- 3y -THR given in
form of cereal grains
and pulses with salt
and jaggery
DFS and edible
fortified oil are
supplied to
AWC, however,
wheat and rice
are procured
under WBNP of
Ministry.
12Gujarat MS–(Sukhadi, Vaghreli
Khichadi, Sheero, Mut hiya
with GLVs, Sheero/Suk,
Hadi sweet pudla)
HCM–(Thepla+ Tuver
Dal, Thepla+dudhi chan
a veg, Veg pula+Chana
dal, Bhat and Veg Dushi
Dhebra+Chana Veg
Khichadi) Quantity- 50g-
120g
6m- 3y & SAM
-Balshakti (weaning
food) Wheat, Besan,
Soyabean Fl our, Sugar,
Oil), PW&LM–Matrush
akti
Fortified Oil and
double fortified
salt is
used in SNP.
Foritified wheat
flour is in process
13Haryana MS–Channa Murmura
& Groundnut mixture +
Panjiri.
HCM–Bharwa Parantha,
Aloo poori, meethe
Chawal, Pulao meetha
Dalia, Gulgule; Quantity
- MS- 25-50g, HCM -110-
120g
6m-18m–THR given
in the form of Panjiri,
1.5y-3 y- HCM is given
similar to 3-6 yr, SAM-
paushtik panjiri as THR
(Weekly/ Fortnightly),
200 g, PW&LM–HCM–
Bharwa
Parantha, Aloo poori,
meethe Chawal, Pulao
meetha Dalia, Gulgule
DFS, Fortified
panjiri supplied
in urban projects
of the State,
Fortified Wheat
Flour supplied
in 2 blocks of
District Ambala
(naraingarh,
barara) on pilot
basis through
HAFED, from
march. Wheat
Annexures
157 S.No. States
Morning Snack (MS)/Hot
Cooked Meal (HCM)
Take-Home Ration
Fortified food
items used in SNP
Flour to be
supplied in
Distcrit Ambala
and karnal, F.
Edible oil to be
supplied in all
distrcits and
panjiri plant by
HAFED
14Himachal
Pradesh
MS- Nutrimix, Oat bisuits,
ajwain biscuits, HCM–rice
khichdi, meetha rice,
sweet dalia, p anner curry,
Quantity- not mentioned
6m-3 y-(Foritifed
Panjiri,+ F. Oat biscuit,
Rice Pularo+ F. Oat
biscui t, Sweet Dali + F.
Ajwain biscuit), SAM–not
mentioned, PW&LM–
Foritifed Panjiri,+ F. Oat
biscuit, Rice Pulao+
F. Oat biscuit, Sweet
Dali + F. Ajwain biscuit,
Sprouted grams+ F. Oat
biscuit
Fortified panjiti,
Foritified biscuits,
DFS, Fortified
refined oil is used
in SNP
15J&K moong rice khichdi, chana
pulao, matter pulao,
moongi rice khichdi ,
chana pulao, matter
pulao; Quantity -60-
210gms
6m-3y–THR is given in
the form of HCM, SAM-
not mentioned, PW&
LM – not mentioned
fortified salt
16Jharkhand Morning snacks–seasonal
fruits, sweet dalia- 58 g,
eggs, HCM khichdi–103 g
6m- 3y -THR given
in the form of panjiri
(wheat flour, ragi flour,
soya flour, Bengal gram,
oil & sugar), SAM- 1.5
times of normal child,
PW&LM–THR given in
the form upma (wheat
semolina, soyabean,
toor dal, sugar, oil,
spice, vitamin & mineral
mix) -150 gm
DFS & fortified
oil are used
17Karnataka Recipe varies from
District to District, Ragi
Kheer, wheat upma,
Moong dal, Gram dal
kheer, sprouted grams,
Chithranna, rice sambhar,
Quantity- not mentioned
6m-3 y -Nutrimix
Powder (in flour fo
rm- milk powder, ragi,
wheat, moo ng dal,
sugar) , Rice kheer mix,
S AM–not mentioned,
P&L–Not men tioned
no
158
Annexures S.No. States
Morning Snack (MS)/Hot
Cooked Meal (HCM)
Take-Home Ration
Fortified food
items used in SNP
18Kerala MS–Ragi porridge,
Nutritive laddoo, Ground
nut chikki, Rice flake and
jaggery, sprouted green
gram. HCM–Broken wheat
upma with ground nut,
Rice flakes with bengal
gram dal and jaggery,
veg. Sambar, payasam
with green gram,
gooseberry chutney, rice
dal khichdi with veg.,
Quantity- not mentioned
6m- 3y–THR –
Amrutham Nutrimix
(weaning food), P&L–
Provided with raw food
as THR (broken wheat/
sesame, jaggery, green
gram, coconut oil,
sandal etc.)
fortified salt is
used in all AWC,
steps have been
initiated for rice
fortification on
pilot basis in
Kannur District,
Amrithum
nutrimix is
fortified with 11
micronutrients
19Lakshad-
weep
biscuits, Horlicks milk,
Quantity- not mentioned
6m–3 y–in form of
THR rice, green gram,
Bengal gram, SAM- not
mentioned, P&L–not
mentioned
HCM- yes, THR-
not mentioned
20 Madhya
Pradesh
roti sabzi dal+ meethi
lapsi, kheer, poori,aloo
matter aloo chana +
poshtic khichdi, roti sabzi
dal+meethi lapsi, veg.
Pulao, kadhi pakoda+
namkeen dalia, roti sabzi
dal+upma, roti sabzi dal\
chawal sambar + meethi
lapsi, Quantity–57g to
155g
6m–3 y- halwa premix
bal ahar pre mix ,
khichdi, atta besan
ladoo & kehu soya barfi
, SAM–not mentio ned,
P&L–not mentioned
Yes
21Maharashtra Chiwda, Murmura, laddu,
shira, chakli, lapsi, usal
khichdi, Quantity- 150-
160gms
6m-3y- in form of raw
grains & groceries
supplied through State
consumer federation
from 1st May, SAM–not
mentioned, P&L–In
form of raw materials
(wheat, dal, spices
F. soyabean oil, DFS,
Chawal, mataki)
Micronutrient
fortified THR
has been
discontinued,
only RAW THR is
given
22Manipur morning snacks sangom
kheer, HCM khichdi
(micronutrient pulse
& rice, oil, groundnut,
turme rice powder, salt),
Quantity- 10gm morning
snacks per child per day
& 40gms per child per
day
6m -3y–Raw material,
RTE lentil, mustard oil,
groundnut, turmeric
powder, salt, rice SAM-
same as 6m- 3y, P&L
-same as 6m-3y
No info.
Annexures
159 S.No. States
Morning Snack (MS)/Hot
Cooked Meal (HCM)
Take-Home Ration
Fortified food
items used in SNP
23Meghalaya Ms- Milk, HCM–Fortified
suji, Fortified Cheera,
kitchdi, dried peas/bengal
gram, Quantity- 75-8 0g
6m-3y–Ready to eat
fortified food items
given–Fortified atta,
milk powder, RTE kheer,
SAM–not mentioned,
P&L–Ready to eat for
tified food items given–
RTE kheer, RTE khichdi,
f. Suji, F, cheera
Fortified atta ,
suji, cheera and
fortified edible
oil, DFS given
24 Mizoram high protein biscuit,
roasted ground nut, fresh
fruits HCM–Khitchdi,
parantha and chann, high
protein soya noodles,
Quantity-58-137g
6m–3y-Energy dense
fortified food, SAM- not
mentioned, P&L–not
mentioned
DFS and fortified
oil distributed in
SNP
25 Nagaland MS-biscuit & cornflake-
100gm per day, HCM-
Rich rice food-50gm,
healthy chow-40gm per
day
THR-Surho kheer mix
& Balbhog kheer 75gm
each per day including
SAM, PM, LM-THR-
surho kheermix &
Balbhog kheer- 100gm
& 80gm per day
yes
26 Orissa MS-Chuda Badam
Laddu-35 gm, HCM-Rice
& egg curry, Rice-80gm,
Egg-1 pc, Oil-3ml, potato-
20gm, onion-10gm
THR-Chhatua-88gm,
Maize Halwa- 60gm,
egg-3pc weekly,
PM,LM- Chhatua-
196gmBadam
Laddu-24.4 gm &
egg-3pc weekly, SAM-
THR- Chhatua-4.9kg,
Baddam Laddu-61 0gm
not mentioned
27 Puducherry Rice khichdi, ragi putu,
boiled egg, Quantity–1
20g
6m–3 y -Micronutrient
Fortified Food
supplements, SAM-
not mentioned, P&L–
Micronutrient Fortified
Food supplements
Not mentioned
28 Punjab (3-6y- Halwa+ Kheer,
Sweet Dalia + Milk,
Halwa+ Panjiri), PW&LM–
Sweet Dalia, Kheer,
Panjiri), Quantity- 100-
140g
6m–3 y–Sweet Dalia,
Kheer, Panjiri given as
HCM, SAM 3-6 years-
Sweet Dalia, Kheer,
Panjiri, Halwa, 120-203g
P&L–Sweet Dalia, Kheer,
Panjiri given as HCM
currently fortified
panjiri and
Ghee are used,
fortification of
other food items
will be finalized
after decision
of Hon’ble High
Court.
160
Annexures S.No. States
Morning Snack (MS)/Hot
Cooked Meal (HCM)
Take-Home Ration
Fortified food
items used in SNP
29 Rajasthan Rice Puffed and roasted
Channa with jaggery,
Halwa, HCM Khichdi,
Dalia, Quantity- 55gm
morn. Snacks per day per
beneficiaries, 80gm HCM
per day per beneficiary
6m–3 y–Yes in the
form of baby mix
(whole wheat, bengal
gram, soyabean, sugar,
edible oil, SAM- not
mentioned, P&L–in
the form of baby mix
(whole wheat, bengal
gram, soyabean, sugar,
edible oil
DFS & BSF oils
are used
30 Sikkim HCM as morning snacks,
HCM as khichdi in day
time, HCM khichdi @
150gm per day per child
kheer @150 gms every
Thursday
6m-3y THR given
in form of poshtik
ahaar (wheat, maize,
soyabean, bengal
gram, sugar & multi
vitamin s), SAM- not
mentioned, P&L–not
mentioned
food is fortified
with multi-
vitamins by FS
SAI guidelines
31Tamil Nadu Tomato rice+ boiled egg,
Mixed rice with
Black Bengal/ Green
Gram, Veg. Pulav+ boiled
egg, lemon rice+ boiled
egg, Dal Rice with boiled
potato, mixed rice,
Quantity- 20-80g
6m-3y -Complementary
food- Sathumavu
(Amylase rich Weanin
g Food), SAM–
Complementary food-
Sathumavu (Amylase
rich Weaning Food)
supplied weekly, P&L–
Complementary food-
Sathumavu (Amylase
rich Weaning Food)
Complementary
weaning food
fortified as per
ICDS guideline
32Telangana Snack Food (MUKURU)
Ready to eat food in
sa vory form at AWC
+HCM Mini HCM) Rice,
dal, Vegetable + Egg;
Quantity- 25g/ day (MS)
+ 14 0g/day(HCM)+ 4
eggs per week
6m–3 y–Balamrutham
-(Ready to eat food in
powder form) and Egg
s, SAM- same as 6m
-3y, P&L One full meal
consists of Rice, Dal,
Oil, Vegetables
No
33 Tripura Monday–Khichuri+gram
Dal with seasonal veg
etables & Soyabean +
Salty Sujir Haloa,
Tues day- Chola/Bengal
Gram with Muri,
Wednesday 1 Boiled Egg,
Thrusday–Chirar Polao,
Friday Chola/Bengal
Gram with Muri, Saturday
-1 (One) Boiled Egg.
Quantity- 30-90 g
6m-3 y–in form of
Raw rice, masoor dal,
raw egg, soyabean,
semolina, bengal gram
and rice flakes, SAM–
(rice , dal, soyabean,
semolina, bengal gram,
rice flakes,) + 10 eggs,
P&L–rice, dal, soyabean,
semolina, bengal gram,
rice flakes,) + 10 eggs
DFS, F. Oil is
used
Annexures
161 S.No. States
Morning Snack (MS)/Hot
Cooked Meal (HCM)
Take-Home Ration
Fortified food
items used in SNP
34 Uttar
Pradesh
RTE as morning
snacks energy dense
ladoo premix, Energy
dense meetha dalia,
micronutrient fortified
enegy dense namkeen
dalia, HCM roti, dal, veg.,
tahri, milk, soyabean,
Quantity- morning snacks
400-450gm per month
6m–3 y–yes in form
of RTE Micronutrient
Fortified energy dense
weaning food, (wheat,
sugar, bengal gram,
groundnut, soyabean,
veg. oil) meetha dalia,
fortifed namkeen dalia
in the form of RTE
weaning dense foods,
energy dense meetha
dalia, fortified namkeen
dalia, SAM–Not
mentioned, P&L-energy
dense ladoo premix,
Energy dense meetha
dalia, micronutrient
fortified enegy dense
namkeen dalia
with minerals &
vita mins
35Uttrakhand MS- Bhuna Chan, Ata &
Suji Halwa, Buni Moon
g phali, poha, boiled
channa, HCM–Dal+Rice,
Nutrila rice, namkeen
parantha, meetha dalia,
namkeen dalia, khichdi;
Quantity- MS- 30g, HC
M- 110g
6m–3 y–Raw
ingredients (Broken
wheat, dal, peanuts,
seasonal fruit), SAM–
Dry ration, P&L–Raw
ingredients (Broken
wheat, dal, peanuts,
seasonal fruit)
DFS
36 West Bengal MS–Poushtik ladoo(@
48g), Boiled egg, banana;
HCM (@ 75-100g)-Rice
+egg curry with potato,
Rice + dal+ veg with soya
nuggets, Veg. Khichdi +
soya nuggets
HCM provided in place
THR
not used
162
Annexures ANNEXURE 4-E
Status of Malnourished Children reported by the States/UTs
S.No.State/UTs
No. of Malnourished
Children
1 Andhra Pradesh55607
2 Bihar389174
3 Chhattisgarh159833
4 Goa60
5 Gujarat93672
6 Haryana 4342
7 Himachal Pradesh 2568
8 Jammu & Kashmir6198
9 Ladakh20
10 Jharkhand13283
11 Karnataka10915
12 Kerala 5587
13 Madhya Pradesh104868
14 Maharashtra81242
15 Odisha22641
16 Punjab600
17 Rajastham8645
18 Tamil Nadu4534
19 Telangana35700
20 UttarPradesh397000
21 Uttarakhand1800
22 West Bengal9996
23 Delhi250
24 Puducherry0
25 Andaman & Nicobar50
26 Chandigarh336
27 Dadar & Nagar Haveli & daman & Diu1245
28 Lakshadweep0
29 Arunachal Pradesh 0
30 Assam11298
31 Manipur17
32 Meghalaya615
33 Mizoram271
34 Nagaland 275
35 Sikkim30
36 Tripura464
Total1423136
Annexures
163 ANNEXURE 5: CONCORDANCE CHECK BETWEEN STATE
TEMPLATE INDICATORS AND MPR/HMIS DATA
Concordance check between state template and MPR data was conducted on the WCD
programme activity indicators. After the verification of data was conducted for the States
and UTs where the State data was greater than or less than to MPR data by 10%, the
final concordance between the indicators are as follow:
Indicator
Data received
from States
Data from
MPR
State to
MPR data
THR received by children aged 6-36 months for
March 2020
36695223 36097901 101.7%
THR received by pregnant women and
lactating women for March 2020
11533093 11663940 98.8%
Concordance check between state template and HMIS data was conducted on the health
programme activity indicators. After the verification of data was conducted for the States
and UTs where the State data was greater than or less than to MPR data by 10%, the
final concordance between the indicators are as follow:
Indicator
Data received
from States
Data from
HMIS
State to
HMIS data
Total no. of pregnant women who registered
for ANC in first trimester
1564077 1573680 99.4%
Total No. of pregnant women who received 4
or more ANC check-ups
1686736 1698898 99.3%
Total No. of pregnant women given TT2/
Boosters
2187310 1848705 118.3%
Total No. of pregnant women given 1
Albendazole tablet after 1st trimester
993136 989949 100.3%
Total No. of pregnant women given 180 IFA
tablets during ANC
1957920 1997765 97%
Total No. of lactating women given 180 IFA
tablets
1368423 984072 139.1%
Total No. of children 6-59 months who were
provided at least 8-10 doses of IFA syrup per
month
13273124 14288047 93%
Percentage of newborn breastfed within one
hour of birth (Early Initiation of Breastfeeding)
81.98 85.37 96%
164
Annexures ANNEXURE 6: TOP AND BOTTOM PERFORMING STATES/UTS
BASED ON INDICATORS USED IN RUBRIC
The performance of States/UTs is based on a rubric which comprises of 4 themes, which
consists of number of indicators (Annexure 2). The top and bottom performing States
are as follows:
ANNEXURE 6-A: GOVERNANCE & INSTITUTIONAL MECHANISM
a. Fund utilization by States/UTs
Performance of top 5 and bottom 5 States/UTs are as follows:
Top 5 performing States/UTsBottom 5 performing States/UTs
State/ UT Fund Utilized State/UT Fund Utilized
Nagaland87% Punjab22%
Meghalaya78% Puducherry22%
Sikkim71% Tripura16%
Mizoram67% Arunachal Pradesh9%
Lakshadweep 65% Odisha8%
b. Constitution of Committees and Resource Groups
Apart from the following States/UTs, all the remaining States/UTs have constituted
committees and resource groups in 100% districts. The bottom performing States/UTs
are:
Constitution of DRGs Constitution of BRGs
Constitution of CAP
committees
State/UT
% districts
with DRGs
State/UT
% districts
with BRGs
State/UT
% districts
with CAP
Delhi82% Tripura 97% Chhattisgarh 96%
Puducherry 50% Meghalaya 89% Odisha93%
Assam0% Assam1% Puducherry 50%
Ladakh0% Ladakh0% Assam18%
———— Goa0%
Annexures
165 ANNEXURE 6-B: STRATEGY AND PLANNING
a. % of districts that developed and submitted CAP for FY 2020-21
States/UTs where 100% districts that developed and submitted CAP for FY 2020-21 are
as follows:
Category of
State
State with 100% districts that developed and submitted CAP
for FY 2020-21
Total
Large States Andhra Pradesh, Bihar, Gujarat, Haryana, Himachal Pradesh,
Jharkhand, Karnataka, Madhya Pradesh, Maharashtra, Punjab,
Rajasthan, Tamil Nadu, Uttar Pradesh
13
Small States Arunachal Pradesh, Meghalaya, Mizoram, Nagaland, Sikkim,
Tripura
6
Union
Territories
Chandigarh, Dadar & Nagar Haveli and Daman & Diu, Jammu
& Kashmir, Ladakh, Lakshadweep
5
The 5 States/UTs with the least number of districts that developed and submitted CAP
for FY 2020-21 are as follows:
State/UT
% districts that developed and
submitted CAP for FY 2020-21
Puducherry 50%
Assam18%
Uttarakhand0%
Goa0%
Andaman & Nicobar Island0%
166
Annexures ANNEXURE 6-C: INPUTS FOR SERVICE DELIVERY AND CAPACITY-
DEPARTMENT OF WOMEN AND CHILD DEVELOPMENT
a. Human Resources
States/UTs that filled 100% HR positions are as follows:
Category of
State
100% Joint Coordinator positions filledTotal
Large States
Andhra Pradesh, Bihar, Gujarat, Himachal Pradesh,
Jharkhand, Kerala, Madhya Pradesh, Maharashtra, Rajasthan,
Tamil Nadu, Telangana, Uttarakhand
12
Small States Meghalaya, Mizoram, Nagaland, Sikkim4
Union Territories
Chandigarh, Dadar & Nagar Haveli and Daman & Diu, Delhi,
Jammu & Kashmir
4
Category of
State
100% Consultant positions filledTotal
Large States
Assam, Bihar, Gujarat, Himachal Pradesh, Madhya Pradesh,
Rajasthan, Telangana
7
Small States Mizoram1
Union Territories
Andaman & Nicobar Island, Chandigarh, Dadar & Nagar
Haveli and Daman & Diu
3
Category of
State
100% Project Associate positions filledTotal
Large States
Andhra Pradesh, Bihar, Gujarat, Haryana, Himachal Pradesh,
Kerala, Madhya Pradesh, Rajasthan, Telangana, Uttarakhand
10
Small States Meghalaya, Mizoram, Nagaland, Sikkim4
Union Territories
Andaman & Nicobar Island, Chandigarh, Dadar & Nagar
Haveli and Daman & Diu, Lakshadweep
4
The following States/UTs had not filled any positions for Joint Coordinator, Consultant,
and Project Associate:
Joint Coordinator ConsultantProject Associate
PunjabPunjabPunjab
GoaGoaGoa
TripuraTripuraTripura
PuducherryPuducherryPuducherry
HaryanaOdisha Odisha
ChhattisgarhUttar PradeshUttar Pradesh
Andaman & Nicobar Island Jammu & KashmirJammu & Kashmir
Arunachal PradeshSikkimArunachal Pradesh
Lakshadweep -Delhi
Annexures
167 a. Supplies
States/UTs that distributed 100% of supplies are as follows:
Category of
State
100% mobile phones distributed to districtsTotal
Large States
Andhra Pradesh, Bihar, Gujarat, Haryana, Jharkhand, Maharashtra,
Tamil Nadu, Uttarakhand
8
Small States Meghalaya, Mizoram, Nagaland, Tripura4
Union
Territories
Andaman & Nicobar Island, Chandigarh, Dadar & Nagar Haveli
and Daman & Diu, Delhi, Ladakh
5
Category of
State
100% weighing scale (adult) distributedTotal
Large States
Andhra Pradesh, Gujarat, Himachal Pradesh, Karnataka, Kerala,
Maharashtra, Punjab, Tamil Nadu, Telangana, Uttarakhand
10
Small States Goa, Meghalaya, Mizoram, Nagaland4
Union
Territories
Andaman & Nicobar Island, Chandigarh, Dadar & Nagar
Haveli and Daman & Diu, Delhi, Jammu & Kashmir, Ladakh,
Lakshadweep, Puducherry
8
Category of
State
100% weighing scale (infant) distributedTotal
Large States
Andhra Pradesh, Gujarat, Himachal Pradesh, Karnataka, Kerala,
Madhya Pradesh, Maharashtra, Punjab, Tamil Nadu, Telangana,
Uttarakhand
11
Small States Goa, Meghalaya, Mizoram, Nagaland4
Union
Territories
Andaman & Nicobar Island, Chandigarh, Dadar & Nagar
Haveli and Daman & Diu, Delhi, Jammu & Kashmir, Ladakh,
Lakshadweep, Puducherry
8
Category of
State
100% infantometer distributedTotal
Large States
Andhra Pradesh, Bihar, Gujarat, Haryana, Himachal Pradesh,
Karnataka, Kerala, Madhya Pradesh, Maharashtra, Punjab, Tamil
Nadu, Telangana, Uttarakhand
13
Small States Goa, Meghalaya, Mizoram, Nagaland4
Union
Territories
Andaman & Nicobar Island, Chandigarh, Dadar & Nagar
Haveli and Daman & Diu, Delhi, Jammu & Kashmir, Ladakh,
Lakshadweep, Puducherry
8
Category of
State
100% stadiometer distributedTotal
Large States
Andhra Pradesh, Gujarat, Haryana, Himachal Pradesh, Karnataka,
Kerala, Madhya Pradesh, Maharashtra, Punjab, Tamil Nadu,
Telangana, Uttarakhand
12
Small States Goa, Meghalaya, Mizoram, Nagaland4
Union
Territories
Andaman & Nicobar Island, Chandigarh, Dadar & Nagar
Haveli and Daman & Diu, Delhi, Jammu & Kashmir, Ladakh,
Lakshadweep, Puducherry
8
168
Annexures The least performing States/UTs on distribution of supplies are as follows:
Mobile Phones
Weigh-scale
(Adult)
Weigh-scale
(Infant)
Infantometer Stadiometer
Odisha Odisha OdishaOdisha Odisha
Arunachal
Pradesh
Arunachal
Pradesh
Arunachal
Pradesh
Arunachal
Pradesh
Arunachal
Pradesh
Kerala Manipur Manipur Manipur Manipur
Himachal
Pradesh
Haryana Haryana Uttar Pradesh Uttar Pradesh
Punjab Sikkim SikkimChhattisgarh Sikkim
— Rajasthan———
Training and Capacity Building
States/UTs that have trained 100% staff on e-ILA and dashboard/mobile phones are as
follows:
Category of
State
100% LS trained on e-ILATotal
Large States
Andhra Pradesh, Gujarat, Madhya Pradesh, Odisha, Rajasthan,
Tamil Nadu, Uttar Pradesh
7
Small States Meghalaya, Sikkim, Tripura3
Union
Territories
Andaman & Nicobar Island, Chandigarh, Dadar & Nagar
Haveli and Daman & Diu, Jammu & Kahsmir
4
Category of
State
100% AWW trained on e-ILATotal
Large States Gujarat, Madhya Pradesh, Odisha, Tamil Nadu, Uttar Pradesh 5
Small States Sikkim1
Union
Territories
Andaman & Nicobar Island, Chandigarh, Dadar & Nagar
Haveli and Daman & Diu, Jammu & Kashmir
4
Category of
State
100% CDPOs trained on Dashboard/MobileTotal
Large States Andhra Pradesh, Bihar, Gujarat, Kerala, Tamil Nadu5
Small States Nagaland, Sikkim, Tripura3
Union
Territories
Andaman & Nicobar Island, Chandigarh, Dadar & Nagar
Haveli and Daman & Diu, Delhi, Lakshadweep
5
Category of
State
100% LS trained on Dashboard/MobileTotal
Large States
Andhra Pradesh, Bihar, Gujarat, Madhya Pradesh, Tamil Nadu,
Uttarakhand
6
Small States Meghalaya, Nagaland, Sikkim3
Union
Territories
Andaman & Nicobar Island, Chandigarh, Dadar & Nagar
Haveli and Daman & Diu, Delhi
4
Annexures
169 States/UTs that had 0% staff trained on e-ILA and dashboard/mobile phones are as
follows:
Category of
State
0% LS trained on e-ILATotal
Large States
Assam, Haryana, Karnataka, Kerala, Punjab, Telangana,
Uttarakhand
7
Small States Arunachal Pradesh, Goa, Mizoram, Nagaland3
Union
Territories
Delhi, Ladakh, Lakshadweep, Puducherry4
Category of
State
0% AWW trained on e-ILATotal
Large States
Assam, Haryana, Karnataka, Kerala, Punjab, Telangana,
Uttarakhand
7
Small States Arunachal Pradesh, Goa, Meghalaya, Mizoram, Nagaland4
Union
Territories
Delhi, Ladakh, Lakshadweep, Puducherry4
Category of
State
0% CDPOs trained on dashboard/mobile phonesTotal
Large States Assam, Haryana, Karnataka, Kerala, Uttarakhand5
Small States Goa, Mizoram2
Union
Territories
Jammu & Kahsmir, Ladakh2
Category of
State
0% LS trained on dashboard/mobile phonesTotal
Large States Assam, Haryana, Karnataka, Punjab4
Small States Goa1
Union
Territories
Jammu & Kashmir, Ladakh, Puducherry3
170
Annexures ANNEXURE 6-D: SERVICE DELIVERY ESSENTIALS- DEPARTMENT
OF HEALTH
a. Infrastructure
Out of sanctioned health facilities, 100% facilities are functional in the following States/
UTs:
Category of
State
100% sub-centres functionalTotal
Large States
Andhra Pradesh, Assam, Chhattisgarh, Haryana, Himachal
Pradesh, Karnataka, Kerala, Madhya Pradesh, Odisha, Tamil
Nadu, Telangana, Uttar Pradesh, Uttarakhand
13
Small States Goa, Sikkim2
Union
Territories
Andaman & Nicobar Island, Dadar & Nagar Haveli and Daman
& Diu, Delhi, Jammu & Kashmir, Ladakh, Puducherry
6
Category of
State
100% CHCs functionalTotal
Large States
Andhra Pradesh, Chhattisgarh, Haryana, Himachal Pradesh,
Karnataka, Kerala, Madhya Pradesh, Maharashtra, Odisha,
Rajasthan, Tamil Nadu, Telangana, Uttar Pradesh, Uttarakhand
14
Small States Goa, Manipur, Meghalaya, Sikkim4
Union
Territories
Andaman & Nicobar Island, Chandigarh Dadar & Nagar
Haveli and Daman & Diu, Delhi, Jammu & Kashmir, Ladakh,
Lakshadweep, Puducherry
8
Category of
State
100% HWCs functionalTotal
Large States Andhra Pradesh, Kerala, Punjab3
Small States Goa, Nagaland2
Union
Territories
Chandigarh, Dadar & Nagar Haveli and Daman & Diu,
Lakshadweep
3
Out of sanctioned health facilities, following States/UTS had lowest number of functional
health facilities:
Sub-centres functional CHCs functionalHWCs functional
State % sub-centre State % CHCs State % HWCs
Punjab77% Tripura 88% Maharashtra 36%
Nagaland76% Assam 82% Ladakh33%
Lakshadweep 71% Punjab 82% Puducherry 33%
Arunachal
Pradesh
63% Nagaland 64% Bihar30%
Bihar60% Bihar 43% Haryana26%
Annexures
171 Human Resource
Performance of top 5 and bottom 5 States/UTs on ANM positions filled are as follows:
Top 5 performing States/UTsBottom 5 performing States/UTs
State/ UT ANM position filled State/UT ANM position filled
Arunachal Pradesh100% Karnataka78%
Nagaland 100% Himachal Pradesh71%
Lakshadweep100% Uttar Pradesh61%
Odisha100% Tripura56%
Assam99% Bihar52%
172
Annexures ANNEXURE 6-E: PROGRAMME ACTIVITIES AND INTERVENTION
COVERAGE-DEPARTMENT OF WOMEN AND CHILD DEVELOPMENT
a. Take Home Ration
States/UTs that distributed THR to 100% beneficiaries registered at AWCs are as follows:
Category of
State
THR distributed to 100% pregnant womenTotal
Large States
Gujarat, Jharkhand, Kerala, Maharashtra, Odisha, Rajasthan,
Tamil Nadu
7
Small States Meghalaya, Mizoram, Tripura3
Union
Territories
Andaman & Nicobar Island, Dadar & Nagar Haveli and Daman
& Diu, Delhi, Ladakh, Lakshadweep, Puducherry
6
Category of
State
THR distributed to 100% lactating womenTotal
Large States Jharkhand, Kerala, Maharashtra, Odisha, Tamil Nadu5
Small States Goa, Meghalaya, Mizoram, Tripura4
Union
Territories
Andaman & Nicobar Island, Delhi, Ladakh, Lakshadweep,
Puducherry
5
Category of
State
THR distributed to 100% children (6-36 months)Total
Large States
Jharkhand, Kerala, Maharashtra, Odisha, Tamil Nadu, Uttar
Pradesh
6
Small States Meghalaya, Mizoram, Tripura3
UTs
Andaman & Nicobar Island, Dadar & Nagar Haveli and Daman
& Diu, Delhi, Ladakh, Lakshadweep
5
States/UTs with least distribution of THR are as follows:
Pregnant womenLactating womenChildren (6-36 months)
State % covered State % covered State % covered
Karnataka 80% Punjab76% Sikkim77%
Punjab78% Haryana63% Punjab65%
Bihar65% Bihar62% Haryana59%
Haryana 63% Jammu &
Kashmir
51% Jammu &
Kashmir
54%
Jammu &
Kashmir
49% Puducherry 49% Bihar52%
Annexures
173 b. Children (0-5 years) weighed:
Top and bottom performing States/UTs on % of children (0-5 years) registered under
AWC weighed at AWC are as follows:
Top performing States/UTsBottom performing States/UTs
State/ UT Children weighed State/UT Children weighed
Karnataka100% Nagaland44%
Lakshadweep100% Telangana37%
Maharashtra100% Kerala18%
Odisha100% Bihar16%
Sikkim100% Ladakh15%
Tamil Nadu100% Arunachal Pradesh4%
174
Annexures ANNEXURE 6-F: PROGRAMME ACTIVITIES AND INTERVENTION
COVERAGE- DEPARTMENT OF HEALTH
a. Programme Activities:
Top 5 and bottom 5 performing States/UTs on the 14 indicators that were used in rubric
are as follows:
Top States/UTs Bottom States/UTs Top States/UTs Bottom States/UTs
% of newborn breastfed within one hour of
birth
% of children (12-23 mo) fully immunized
Gujarat 100%Nagaland 67% Haryana 100% Lakshadweep 5%
Lakshadweep 100%Sikkim 50% Uttar Pradesh96% Delhi 4%
Odisha 96% Rajasthan 7%
D &N Haveli
Daman & Diu
95% Kerala 3%
Assam 96% Puducherry 4% Telangana 94%
Arunachal
Pradesh
2%
Andhra
Pradesh
96% Ladakh 0%
Andaman &
Nicobar
93% Nagaland 1%
% of children (6-59 mo) provided at least
8-10 doses of IFA syrup per month
% of pregnant women who registered for
ANC in first trimester
Himachal
Pradesh
100%Manipur 0% Tamil Nadu 95% Ladakh 59%
Sikkim 100%Tripura 0%
D &N Haveli
Daman & Diu
95% Goa 52%
Puducherry 98%
Arunachal
Pradesh
0% Chhattisgarh 93%
Arunachal
Pradesh
41%
Telangana 65% Goa0% Assam 91% Meghalaya 39%
Haryana 58% Nagaland 0% Odisha 90% Puducherry 36%
Andaman &
Nicobar
44% Rajasthan 0% Maharashtra 88% Nagaland 31%
D &N Haveli
Daman & Diu
43% Lakshadweep 0% Gujarat 96% Punjab 7%
Maharashtra 39% Delhi 0% Kerala 85% Tripura 7%
% of pregnant women who received 4 or
more ANCs
% of pregnant women who were given 180
IFA Tablets
Chhattisgarh 100%Ladakh 62% Chhattisgarh 100%
Jammu &
Kashmir
65%
Kerala 100%Manipur 60% Kerala 100%
Andaman &
Nicobar
64%
Chandigarh 100%Rajasthan 58% Chandigarh 100%Manipur 50%
Maharashtra 97% Meghalaya 46% Karnataka 100%Rajasthan 46%
Annexures
175 Top States/UTs Bottom States/UTs Top States/UTs Bottom States/UTs
D &N Haveli
Daman & Diu
95%
Arunachal
Pradesh
25% Uttar Pradesh100%Meghalaya 44%
Karnataka 93% Nagaland 19%Telangana 100%Nagaland 29%
Lakshadweep 90% Tripura 6% Maharashtra 100%Punjab 6%
Andhra
Pradesh
90% Punjab 6% Gujarat 99% Tripura 3%
% of lactating women who were given 180
IFA Tablets
% of 5-9 years children who were given
weekly IFA tablets
Assam 100%Puducherry 12%
Himachal
Pradesh
100%
Jammu &
Kashmir
3%
Chandigarh 100%Meghalaya 8% Gujarat 100%Ladakh 2%
Goa 100%Gujarat 6% Puducherry 100%Chattisgarh 0%
Jharkhand 100%Tamil Nadu 3% Uttarakhand 100%
Arunachal
Pradesh
0%
Jammu &
Kashmir
100%Punjab 2% Tripura 97% Haryana 0%
Rajasthan 100%Kerala 2% Chandigarh 94% Nagaland 0%
Sikkim 100%Tripura 1%
Madhya
Pradesh
75% Sikkim 0%
% of pregnant women given TT2/Boosters
% of pregnant women given 1 Albendazole
tablet after first trimester
Andhra
Pradesh
100%Delhi 41%Puducherry 93% Ladakh 10%
Chhattisgarh 100%Nagaland 40% Gujarat 86% Manipur 6%
Jharkhand 100%Puducherry 28%
D & N Haveli
Daman & Diu
81% Kerala 5%
Odisha 100%Punjab 7% Chgattisgarh 80% Punjab 3%
Tamil Nadu 99% Tripura 7% Odisha 76% Tripura 0%
% of children (0-59 mo) diarrhoea cases
reported treated with ORS & Zinc
% of home visits to household with
pregnant mother to counsel on appropriate
measures
Gujarat 100%
Andhra
Pradesh
75% Puducherry 100%Jharkhand 80%
Chhattisgarh 100%Ladakh 69%
Jammu &
Kashmir
98%
Andaman &
Nicobar
80%
Odisha 100%
D & N Haveli
& Daman &
Diu
57% Uttarakhand 98% Maharashtra 75%
Karnataka 100%Jharkhand 35% Chhattisgarh 97% Ladakh 71%
Madhya
Pradesh
100%
Jammu &
Kashmir
29% Haryana 96% Karnataka 67%
176
Annexures Top States/UTs Bottom States/UTs Top States/UTs Bottom States/UTs
Himachal
Pradesh
100%Uttarakhand 28%
D & N Haveli
& Daman &
Diu
90% Assam 55%
Maharashtra 100%Manipur 26% Tripura 90%
Himachal
Pradesh
51%
Haryana 100%
Andaman &
Nicobar
23% Telangana 88%
Andhra
Pradesh
47%
Assam 100%Kerala 22% Punjab 86% Delhi 34%
Telangana 100%MeghalayaSikkim 84%
Arunachal
Pradesh
18%
Goa 100%SikkimOdisha 82%
Madhya
Pradesh
0%
Uttar Pradesh100%PuducherryTamil Nadu 81% - -
Annexures
177 PRESERVING PROGRESS ON NUTRITION IN INDIA:
POSHAN ABHIYAAN IN PANDEMIC TIMES
Designed b y
JULY 21
POSHAN ABHIYAAN
PRESERVING PROGRESS ON
NUTRITION IN INDIA:
IN PANDEMIC TIMES