Accelerating Progress on Nutrition in India: What Will it Take - Third Progress Report

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AUTHORS:

This Report is prepared by team at WCD Division, NITI Aayog (Led by-Shri Alok Kumar, Dr Supreet
Kaur, Ms. Anamika Singh) along with a team from International Food Policy Research Institute
(IFPRI) led by Dr Punima Menon.
NITI Aayog acknowledges the contributions of the Ministry of Women and Child Development and
Ministry of Health and Family Welfare for sharing the updated information to prepare the report.
CONTENT
Executive Summary.....................................................................................................07
1. INTRODUCTION.........................................................................................15
1.1. Overview of POSHAN Abhiyaan...........................................................16
1.2. Objective of POSHAN Abhiyaan 3rd report.........................................17
2. WHAT WILL IT TAKE TO ACCELERATE REDUCTIONS IN
UNDERNUTRITION IN INDIA?........................................................................19
2.1 About the LiST model and use of the model for projecting
the impact of scaling up interventions in India...................................22
2.2. Potential impact of scaling-up of interventions on wasting
(LiST modeling).....................................................................................25
2.2.1. Stunting reduction: Insights on “how” from
State success stories................................................................26
2.3. Potential impact of scaling-up of interventions on
wasting (LiST modelling).....................................................................29
2.4. Potential impact of scaling-up of interventions on anaemia
among women of reproductive age (LiST modeling)..........................30
2.5 Summary...............................................................................................31
3. PERFORMANCE OF POSHAN ABHIYAAN PILLARS AND STATUS
OF DELIVERY PLATFORMS.........................................................................33
3.1 Core pillars of POSHAN Abhiyaan........................................................34
3.1.1. Technology.....................................................................................34
3.1.2. Convergence...................................................................................38
3.1.3. Behavior change communication.................................................40
3.1.4 Capacity building............................................................................44
3.2. Core platforms for intervention delivery..............................................47
3.2.1. Integrated Child Development Services........................................47
3.2.2. Pradhan Mantri Matru Vandana Yojana (PMMVY)......................48
3.2.3. National Health Mission ...............................................................52
3.3 Summary...............................................................................................57 4. ADDRESSING MAJOR CHALLENGES ON THE ROAD TO A
WELL-NOURISHED INDIA.............................................................................59
4.1. Complementary feeding.......................................................................60
4.1.1. Status..............................................................................................60
4.1.2. Recommendations for key actions...............................................62
4.2. Anaemia................................................................................................64
4.2.1. Status..............................................................................................64
4.2.2. Recommendations for key actions...............................................65
4.3. Micronutrient deficiencies [1 to 19-year-old population only]...........66
4.3.1. Status..............................................................................................66
4.3.2. Recommendations for key actions...............................................68
4.4. Emerging cross-cutting challenges.....................................................69
4.4.1. Urbanization...................................................................................70
4.4.2. Overweight, non-communicable diseases and the
food environment...........................................................................72
5. LOOKING AHEAD FOR TRANSFORMING NUTRITION IN INDIA...................75
5.1. Recommendations for accelerating current trends in
addressing key undernutrition goals...................................................76
5.2. Recommendations for strengthening key POSHAN Abhiyaan
pillars.....................................................................................................77
5.3. Recommendations for interventions delivery through
core platforms (ICDS & NHM)..............................................................78
5.4. Addressing challenges (old and new) for transforming
nutrition in India....................................................................................79
Reference List
Annexures Figure 1: Targets of the POSHAN Abhiyaan
Figure 2: The LIST framework
Figure 3: Baseline coverage of interventions included in the modelling for India
Figure 4: Stunting and wasting reduction by scaling-up nutrition interventions (2016-2025)
Figure 5a: Changes in the immediate determinants of nutrition in Chhattisgarh, Gujarat, Odisha
and Tamil Nadu (2006-16)
Figure 5b: Factors contributing to changes in height-for-age Z-scores (stunting) among
6-59-month-old children between 2006 and 2016
Figure 6: Evolution and innovation of nutrition-related State-specific policy and programme
initiatives in Chhattisgarh, Gujarat, Odisha and Tamil Nadu (2006-16)
Figure 7A: Wasting reduction by scaling-up nutrition interventions (2016-2025)
Figure 7B: Projected prevalence of wasting in 2025, by intervention
Figure 8: Anaemia reduction by scaling-up nutrition interventions (2016-2025)
Figure 9: Pillars of POSHAN Abhiyaan
Figure 10: Effective household convergence in Andhra Pradesh: Pregnancy versus postnatal/
childhood
Figure 11: Trends in infant and young child feeding practices in India
Figure 12. Anaemia among children & adolescents, India, CNNS
Figure 13. Percentage of adolescents with Vitamin A, Vitamin D, and Zinc deficiency, India, CNNS
Figure 14. Percentage of adolescents with Vitamin B12 and Folate deficiency, India, CNNS
Figure 15. Prevalence of nutrition outcomes among children (0-59 months old), by place of
residence, NFHS-4 2016
Figure 16. Prevalence of nutrition outcomes among adolescent girls (15-19-year-old) and
women (15-49-year-old), by place of residence, NFHS-4 2016
Figure 17. Prevalence of immediate determinants of nutrition, by place of residence, NFHS-4
2016
LIST OF FIGURES LIST OF BOXES
Box A: Malnutrition and COVID19: No time to waste
Box 1: Modelling tools in Nutrition
Box 2: State-specific case study on ICDS-CAS roll-out (Madhya Pradesh)
Box 3: Jan Aandolan - Poshan Maah 2019
Box 4: Implementation status of POSHAN Abhiyaan in Rajasthan
Box 5: Take-home ration – How to optimize its use?
Box 6: Growth monitoring
Box 7: Quality monitoring of maternal, infant and young child nutrition service delivery at
village health, sanitation and nutrition days and community-based events
Box 8: Key insights on health outcomes: Aspirational Districts Programme
LIST OF TABLES
Table 1: Projected number of stunting cases averted among children under 5 years by
type of interventions
Table 2: Platform-wise reach and recall rates 7

EXECUTIVE
SUMMARY 8
Background
POSHAN Abhiyaan, or National Nutrition Mission, is the Government of India’s flagship program
to improve nutritional outcomes for children, pregnant women and lactating mothers. Launched
in 2018, it strives to reduce the levels of stunting, undernutrition, anaemia and low birth weight
babies and address the problem of malnutrition in a mission-mode. POSHAN Abhiyaan’s third
progress report takes stock of the roll-out status of the Mission on the ground and implementation
challenges encountered at various levels.
The initial Report I and II, focuses majorly on the POSHAN Abhiyaan preparedness and
implementation by States and UTs, respectively. For the preparation of the earlier Reports data
from States and UTs WCD and Health Department was collated with the help of pre-structured
format. Further, analysis and ranking of States was done on the data received.
POSHAN Abhiyaan’s third progress report (October 2019-April 2020) takes stock of the roll-out
status on the ground and implementation challenges encountered at various levels through large
scale datasets already available at public domain like National Family and Health Survey (NHFS-4)
and Comprehensive National Nutrition Survey (CNNS).
What will it take to accelerate reductions in undernutrition
in India?
To assess how POSHAN Abhiyaan can accelerate current trends of decline in stunting, wasting
and anaemia by scaling up coverage of key interventions, a modelling analysis was done using
the Lived Saved Tool (LiST). Given the ambitions of POSHAN Abhiyaan and activities underway
already to accelerate actions, the model assumed that the coverage of all interventions will reach
90% in 2022 and 95% in 2025. Insights were also drawn from an in-depth retrospective mixed
methods analysis of selected States (Chhattisgarh, Gujarat, Odisha and Tamil Nadu) that had
successfully accelerated stunting reductions in the decade between 2006 and 2016.
The mixed methods stunting reduction success cases in selected States highlighted that in
addition to the scaling up of interventions, important investments in social determinants,
especially related to the status of girls and women (education during childhood, reducing
early marriage and early pregnancy, improving care during and after pregnancy), poverty
and food security, were important for reducing stunting. States also offer important lessons
on how these changes were facilitated – ownership of a common vision, capable and well-
supported administration and technical partners, adequate and flexible financing, strengthening
implementation systems to enable intervention delivery, working with a range of partners and
civil society, and finally, using data and evidence to track progress and learn. Currently, POSHAN
Abhiyaan actions to address social determinants other than sanitation, which is well covered under
national priorities, need to gain momentum.
In this third report, our assessment also covers the status and roll-out of systems strengthening
efforts, as well as successes and challenges related to the core platforms of Integrated Child
Development Scheme (ICDS) and National Health Mission (NHM) – which implicate focused
attention to accelerate intervention coverage and convergence to meet the goals of
POSHAN Abhiyaan. 9
What are some major challenges and key recommendations for
transforming nutrition in India
Addressing the complex problem of malnutrition in India is a colossal task that needs a meticulous
and multi-pronged approach. Through implementing POSHAN Abhiyaan, the Government of India
aims to reduce child stunting, underweight and low birth weight by 2 percentage points per annum
and anaemia among children (and young females) by 3 percentage points per annum. In addition,
new findings from the Comprehensive National Nutrition Survey (CNNS 2016-18) have again
highlighted the role of micronutrient malnutrition - anaemia and other micronutrient deficiencies.
To state the emerging challenges like micronutrient deficiencies, and the cross-cutting challenges
of urbanization and of growing overweight and obesity, our primary recommendation is to first
acknowledge that the new findings, as documented in this report, need attention. Deeply investing
in improving dietary quality – through a primary focus on dietary diversity and diet quality – will
help achieve multiple nutrition goals. In addition, following the path already laid out on fortification
of key staples will help mitigate, at least partially, some micronutrient deficiencies. The focus of
work on urban nutrition must go well beyond catering to the challenges of the urban poor and must
engage stakeholders across the board to address issues of overweight and obesity as well.
Thus, it can be interpreted that for solving the malnutrition challenge in India requires the nutrition
policy and program having lasting and old challenges, as well as on keeping pace with new and
emerging challenges. Following this, to strengthen POSHAN Abhiyaan for improving key nutrition
outcomes, we offer the following recommendations:
A. Recommendations for accelerating current trends in addressing key
undernutrition goals
(Based on Lived Saved Tool modelling analysis and insights drawn from an in-depth retrospective
mixed method analysis of selected States that successfully accelerated
stunting reductions, especially in the decade between 2006 and 2016)
Stunting
- For stunting, In the aspirational scenario model, the models predict a stunting decline from
37.5% in 2016 to 31.9% in 2022 and 30.1% in 2025. The projected number of stunting cases to
be averted among children under 5 years was ~7 million in 2022 and 9 million in 2025.
- The LiST model emphasises improving complementary feeding using both behaviour change
interventions and the complementary food supplements in ICDS, for stunting reduction.
Appropriate complementary feeding would avert about 60% of the total stunting cases.
- The success cases in selected States highlighted the importance of investments in girls and
women (education during childhood, reducing early marriage and early pregnancy, improving
care during and after pregnancy) along with other social determinants for reducing stunting.
- Improved water, sanitation, hand washing with soap and hygienic disposal of children’s stools
were other effective interventions which would avert about a quarter of the stunting cases. 10
Wasting
- The LiST model suggested including interventions that go beyond the treatment of severe
acute malnutrition (SAM) and include those that also address moderate wasting, have the
potential to achieve larger declines in wasting than by tackling SAM alone.
- Facility-based treatment of SAM, implemented by the MoHFW, needs to scale-up to reach all
those needing in-patient care. The ICDS already includes interventions to address moderate
malnutrition but the quality and reach of ICDS food supplements and the improvements in
screening and referral are imperative to ensure that interventions work as well as they should.
- Overall, it is urgent that a full strategy for prevention and integrated management of wasting
be released nationally.
Anaemia
• The LiST model estimated that a scale-up scenario that focuses only on health sector
interventions will achieve modest improvements in anaemia among women of reproductive
age. Therefore, more attention is needed on other determinants and interventions.
B. Recommendations for strengthening key POSHAN Abhiyaan pillars:
• Technology
- Many States still need to accelerate the procurement of phones and training of providers
and managers.
- Supportive efforts to scale-up technology – servers, network issues, capacity building,
help desks - need attention.
- A State-by-State assessment, using the findings of this report, should drive State-
specific action to close gaps.
• Convergence
• The vision of effective household convergence needs translation from national to
district-level stakeholders. Without a clarity of vision, efforts related to convergent
action planning will remain tokenistic exercises.
• New models for diagnosis, planning and closing of gaps in effective convergence are
needed.
• Behavioral change
- Efforts must be focused on extending the reach of routine platforms, like home visits,
supported by community-based events and mass media, since these have higher reach.
- Interpersonal counselling to support good nutrition practices must reach every family
that has a child in the first two years of life, using existing frontline worker platforms
and all available platforms. All evidence suggests this is important for impact, while the
overall campaign itself works to create a buzz of awareness. 11
• Capacity building
- Investment in the quality of capacity building needs to be a central goal, especially on
growth monitoring and quality of counselling.
- To accelerate the roll out of e-ILA, procurement process of smartphones needs to be
expedited, and training prioritized.
C. Recommendations for strengthening core delivery platforms for POSHAN
Abhiyaan (ICDS & NHM)
• ICDS platform
- Key governance challenges related to financing, supervision vacancies, infrastructure
and more, must be addressed.
- Core interventions such as home visits, THR and growth monitoring need significant
quality improvements. All of these are important to detect and support care and
referrals for wasting and to prevent stunting.
• NHM platform
- Ongoing efforts should continue to focus both on the quality of nutrition interventions
in health services and on routinizing/integrating fully these efforts to reduce missed
opportunities for service delivery. Like, strengthening nutrition interventions into the
existing health platforms, such as Antenatal Care (ANC), Home Based Newborn Care
(HBNC) and Home Based Young child Care (HBYC).
- A key challenge is the use of private care platforms, especially for curative care, and this
will need attention for key interventions, such as diarrhea control and use of zinc.
D. Recommendations for addressing old and new challenges for
transforming nutrition in India
• Addressing complementary feeding, anaemia and micronutrient
deficiencies
- Complementary feeding
o Use all existing program platforms to emphasize complementary feeding at every
possibly contact with families with children under two years of age.
o Ensure strong linkages between counselling and take-home rations in ICDS and ensure
that they reach all the households with a child below two years.
o Improve the composition and quality and then do everything possible to increase the
reach of the take-home rations.
o Address the systems challenges – both in ICDS and in the health sector - that are
currently preventing adequate reach and quality of counselling services, in particular. 12
- Anaemia and micronutrient deficiencies
o Scale-up and strengthen some of the existing interventions in the health system to
address anaemia, including micronutrient supplements, deworming, prevention and
treatment of malaria.
o Accelerate other focus actions of the Anaemia Mukt Bharat (AMB) mission and social
determinants of anaemia.
o A range of other micronutrient deficiencies have been identified, but these do not require
piecemeal, single micronutrient solutions. Invest in improving dietary quality – through
a primary focus on dietary diversity through the food system – to achieve multiple
nutrition goals.
o Staying the course on fortification of key staples will help mitigate, at least partially,
some micronutrient deficiencies.
E. Recognizing and mobilizing to address the emerging and cross-cutting
challenges of urbanization and overweight/obesity
- Identify and acknowledge the new challenges posed by urban food systems and food
environments and urban health service delivery. The focus of work on urban nutrition
must go well beyond catering to the challenges of the urban poor and must engage
stakeholders across the board.
- In both food and health systems in urban contexts, engaging private health care
providers and a range of actors who can help create healthier food environments for a
range of consumers is essential.
- The challenge of overweight, obesity and non-communicable diseases must be
confronted by tackling the food and physical environments in homes, workplaces
and institutions.
- Connect the existing movements, like Eat Right and Fit India with the POSHAN
Abhiyaan’s mission of improving diets for all stakeholders.
Conclusions
As pointed out above, while POSHAN Abhiyaan continues to play an important role in India’s
endeavour against malnutrition; we need to now accelerate actions on multiple fronts. As the LiST
tool modelling study shows, we need to quickly graduate to a POSHAN-plus strategy which apart
from continued strengthening the four pillars of the Abhiyaan also requires renewed focus on
other social determinants in addition to addressing the governance challenges of NHM/ ICDS
delivery mechanisms. 13
Box A: Malnutrition and COVID19: No time to waste

India is rallying a range of efforts to tackle and stay ahead of the COVID19 pandemic.
Current efforts are focused on protecting the health work force, diagnostics,
treatment, contact tracing, and providing optimal care for patients. However, this
is no time to lose focus on India’s efforts to tackle malnutrition. The reason is that
India is the world’s first large country with a high burden of malnutrition to face the
COVID 19 challenge. Although other countries have recognized the added risks that
overweight and non-communicable diseases pose to severity of health outcomes
related to COVID 19, no countries that have experienced the pandemic to date have
had an undernourished population.
Undernutrition matters tremendously in the context of infectious disease, especially
for vulnerable populations like children. Although children have been largely
protected from the risks of COVID19 in other countries, these countries, including
China did not have a burden of child undernutrition. Children, in particular, are more
vulnerable to infection if they are undernourished. In addition, India has a burden of
pneumonia deaths among children under five years of age that is almost five times
higher than China’s burden of pneumonia deaths among children. India’s burden of
pneumonia deaths is attributed substantially to the high levels of undernutrition.
Adult populations that are undernourished are also at greater risk of infection and
of severe outcomes when infected; this is apparent in the context of other infectious
diseases like tuberculosis and HIV.
What does this mean for POSHAN Abhiyaan in the context of COVID19? It means
that efforts to secure good nutrition must be a strong part of the COVID19 prevention.
Ensuring that high impact interventions remain in place is key, but may require
changes to how they are delivered. For instance, food supplements in the ICDS or
IFA tablets for pregnant women may need to be home-delivered; cash transfers in
the context of PMMVY may need to be made smoother or expanded; counselling and
support for breastfeeding and complementary feeding may need to be delivered at
distance or via telephone. Last, but not least, given the importance of underlying
social determinants such as poverty and food insecurity, ensuring that social
protection programs function well, and without interruption, to support households
in a time of crisis is going to be very important.
Government of India has already taken important steps towards adapting health and
nutrition service delivery and expanding the social safety net. In the next POSHAN
Abhiyaan monitoring report, we will review these efforts. 14 15
CHAPTER 1:
INTRODUCTION 16
POSHAN Abhiyaan (or, National Nutrition Mission) is the Government of India’s flagship
programme to improve nutritional outcomes for children, pregnant women and lactating mothers.
Launched by Hon’ble Prime Minister Shri Narendra Modi on March 8, 2018, with the motto ‘Sahi
Poshan Desh Roshan’, the acronym POSHAN (PM’s Overarching Scheme for Holistic Nourishment)
spelt the Government’s commitment to tackle the issue of malnutrition with well-defined
policies and support from the highest level. The programme aims to ensure service-delivery
and interventions by using technology, behavioural change through convergence and lays down
specific targets to be achieved across different monitoring parameters over the next few years.
The Abhiyaan focuses on strengthening policy implementation (at 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. It aims to reduce child stunting, underweight and low birth weight by 2 percentage
points per annum and anaemia among children (and young females) by 3 percentage points per
annum (Figure 1).
Figure 1 : Targets of the POSHAN Abhiyaan 17
POSHAN Abhiyaan aims to address malnutrition in a mission-mode through a holistic life-cycle
approach. NITI Aayog has played a critical role in shaping the POSHAN Abhiyaan. As a part of
its mandate, NITI Aayog is required to submit Reports on the Status of Implementation of the
POSHAN Abhiyaan bi-annually to the PMO/Cabinet Secretary. It is almost two years since the
launch of POSHAN Abhiyaan, and this is the third bi-annual progress report of its implementation.
Earlier two Reports prepared were based on the data collated from States and UTs WCD and Health
Departments. Based on the data received, computation scores were calculated to assess the
preparedness and implementation status of POSHAN Abhiyaan in States and UTs.
In view of POSHAN Abhiyaan’s current roll-out status, implementation challenges and in-depth
analyses to accelerate reductions in undernutrition, third report draws together insights from
a range of data sources and experiences and aims to offer constructive recommendations to
strengthen the effectiveness of POSHAN Abhiyaan in transforming India’s nutritional status. In
addition, present report also projects estimated impacts using the Lives Saved Tool to model the
potential impact of improving and scaling up intervention coverage.
It encapsulates detailed insights from data, evidence and inputs from multiple stakeholders and
assesses the current nutritional status of the country, on the basis of the latest available national
level datasets. Of the seven pillars of POSHAN Abhiyaan, this report focuses on four (technology,
convergence, behavioural change and capacity building) and provides an update on their current
status of roll-out and perceived challenges in implementation. The Abhiyaan’s success rests on
the ability to engage and transform core program platforms of ICDS and NHM, such that the health
and nutrition interventions can reach households, women and children in the first 1,000 days of
life. This report examines the State of these core platforms and summarizes recent research on
what is needed to engage these platforms effectively to achieve the Abhiyaan’s objectives.
Addressing the complex problem of malnutrition in India is a colossal task that needs a meticulous
and multi-pronged approach. Recent findings from India’s Comprehensive National Nutrition
Survey (CNNS 2016-18) have highlighted the role of micronutrient malnutrition - anaemia and
other micronutrient deficiencies. Along with examining these challenges, this report also looks at
the cross-cutting challenges of urbanization and of growing overweight and obesity.
Present Report is prepared with the capacity to assess current nutrition status of the country
keeping in view the recent or available national level datasets. The outcome indicators influencing
the nutritional status of the target population are also discussed in this Report. The report is
organized as follows: Chapter 2 lays out the findings of the modelling of the potential impact
of scaling up interventions and reviews insights from successful State examples of stunting
reduction, offering insights on what strategies might deliver the most impact; Chapter 3 compiles
insights both on the progress on scaling up key components of POSHAN Abhiyaan as well as
insights on the core implementation platforms – the ICDS and the NHM; Chapter 4 reviews a set of
old and new challenges that are essential to consider for POSHAN Abhiyaan to have impact, and
finally Chapter 5 offers recommendations on a range of actions to magnify and expand the impact
of the range of actions currently underway under POSHAN Abhiyaan. 18 19

CHAPTER 2:
WHAT WILL IT
TAKE TO ACCELERATE
REDUCTIONS IN
UNDERNUTRITION
IN INDIA? 20
How can POSHAN Abhiyaan accelerate current trends in addressing its key undernutrition goals?
To assess this, we draw on insights from two bodies of work.
First, to identify interventions and to assess the impact of scaling them up to accelerate
reductions in undernutrition for India, particularly stunting, wasting and anaemia, we implemented
a modelling analysis. Several modelling tools on nutrition exist (Box 1) and of these, we chose the
Lived Saved Tool (LiST) for its wide-spread use and applicability.
LiST, a computer-based model, estimates the impact of scaling up on maternal, newborn,
and child health, and nutrition interventions in low- and middle-income countries. The
model maps changes in the coverage of specific interventions into changes in outputs such
as wasting or stunting. It has been used globally for modelling and planning maternal and
child health interventions by more than 90 governments, UN agencies, donors. Interventions
in the model cover the first 1000 days and were selected based on the evidence in the
Lancet series on maternal and child undernutrition
(Bhutta et al., 2013).
In present analysis the additional, interventions pertaining to hygiene and sanitation were added.
Second, we drew on state-level success cases in addressing stunting. States within India that had
successfully accelerated stunting reductions, especially in the decade between 2006 and 2016,
were studied using in-depth retrospective mixed methods analyses. The analysis of exemplars
or success States or countries has been gaining traction in recent years. We summarize findings
from success case analyses of four States – Odisha, Chhattisgarh, Gujarat and Tamil Nadu. 21
Box 1: Modelling tools in nutrition
There are a range of modelling tools in nutrition for various purposes. These include the
Lives Saved Tool (LiST) and Optima Nutrition for projecting the impact of scaling-up health
and nutrition interventions, Cost of the Diet to identify optimal combinations of available
foods that meet the nutritional requirements of households, Optifood to provide information
on food-based recommendations to achieve nutritional adequacy for children, Intake
Modelling and Prediction Program (IMAPP) to estimate optimal amount of nutrients for
fortification, and Minimod to identify cost-effective solutions to specific- nutrient related
problems (See Annexure I for details). The two modelling tools that can project the impact
of scaling up of health and nutrition interventions on maternal and child health outcomes
are (1) Lives Saved Tool (LiST); and (2) Optima Nutrition.
The Lives Saved Tool (LiST) is a publicly available computer-based modelling tool that can
be used to estimate the impact of scaling up intervention coverage on undernutrition and
mortality. The model maps changes in the coverage of specific interventions into changes
in outputs such as wasting or stunting. The modelling is affected by the available data
and the quality of available data. LiST does not consider the feasibility of achieving the
estimated targets for coverage within a context.
Optima Nutrition is a quantitative tool that can provide practical advice to governments to
assist with the allocation of current or projected budgets across nutrition programs. The
model contains a geospatial component to determine funding allocations that minimize
stunting, wasting, anaemia or under-five mortality at both the national and regional levels.
It can provide estimates of minimum level of funding required to achieve the nutrition
targets. This modelling tool requires estimates on the costs of scaling-up interventions in
addition to coverage data.
The LiST software was utilised to estimate reductions in stunting, wasting, and anaemia
between 2016 and 2025 because the goal of the modelling was not on resource allocation
but on assessing the impact of an available, already-financed package of interventions.
The LiST software has been used widely for projections of improvements in maternal and
child mortality and for models of changes in child undernutrition. Therefore, it was used to
model the impact of increasing coverage of interventions on nutrition outcomes in India by
2022 and 2025. 22
2.1. About the LiST model and use of the model for projecting
the impact of scaling up interventions in India
The Lives Saved Tool (LiST), version 5.63, was used to project the potential impact of changes in
intervention coverage from 2016 to 2025 on child stunting and wasting as well as anaemia among
pregnant women and women of reproductive age.
This version of the modelling tool is built into a demographic software package (Spectrum) by the
tool developers. For the present analysis, multiple data sources were used. These included data
from the Census of India, 2011, Sample Registration System (SRS) and the fourth round of the
National Family Health Survey (NFHS). The base for demographic, nutrition and health outcomes
were projected using over 190 indicators. The demographic projection was based on 2011 Census
data. Baseline intervention coverage data was taken from NFHS-4 (2015-16), the most recent
survey in India that sampled 601,509 households and provided estimates of most indicators for
the country. Figure 2 presents the list of interventions that were used. Some interventions that
were not available for India were set to zero at baseline (Figure 3).
The interventions included in the model cover a range of interventions included in the POSHAN
Abhiyaan framework of interventions, and those already delivered by the ICDS and the health
system, but not include all interventions.
Three interventions for pregnant females included are:
• tetanus toxoid vaccination,
• iron folic acid (IFA) supplementation, and
• food supplementation during pregnancy.
Two key interventions for covering births included are:
• skilled birth attendance and
• health facility delivery.
Four interventions for infants are:
• immunization,
• vitamin A supplementation,
• ORS and
• zinc provision during diarrhea.
In addition, the LiST included Infant and Young Child Feeding (IYCF) practices as a proxy for
effective programs to support optimal IYCF.
Coverage indicators were available for the most recent birth in the five years preceding
each survey.
Assumptions about changing in intervention coverage: given the ambitions of POSHAN Abhiyaan
and activities underway, we assumed that the coverage of all interventions will increase to 90% in
2022 and to 95% in 2025. Rate of changes were equal for each year between 2016-2022 and 2022-
2025. However, the results have not accounted increase in efforts towards the rigour that has now
come since the launch of POSHAN Abhiyaan, PMMVY, Anaemia Mukt Bharat, HBNC etc. as no
national level dataset captures the improvement of indicator post launch of POSHAN Abhiyaan. 23
Source: https://www.livessavedtool.org/resources
With the upcoming NFHS-5 the analysis will be re-looked keeping in view the various efforts being
put under the ambit of POSHAN Abhiyaan.
Figure 2: The LIST framework 24
Figure 3: Baseline coverage of interventions included in the modelling for India
Note 1: *Ministry of Health and Family Welfare - Children Enrolled Under Nutritional Rehabilitation
Centres https://pib.gov.in/newsite/PrintRelease.aspx?relid=160827 (April 2017) and
correspondence with MoHFW that notes that 1.7 lakh children were covered by NRC treatment; this
forms 20% of the approximately 8 lakh children estimated to need in-facility treatment, and 2% of
the overall number of wasted children (8 million). In the absence of a community-based program
to manage acute malnutrition, the total coverage of children treated for SAM in India is estimated
based only on the reach of the in-patient treatment program.
Note 2: NFHS-4 (2016) was used as the baseline for all intervention coverage, except for SAM
treatment, which was obtained from MoHFW, as noted above. ANC - Antenatal care; IFA - iron and
folic acid; MAM - Moderate acute malnutrition; SAM: Severe acute malnutrition.  25
2.2. What is the potential impact of scaling-up of interventions
on stunting?
In the aspirational scenario model, where coverage of selected interventions was targeted to be
at 90% by 2022, stunting decline was projected from 37.5% in 2016 to 31.9% in 2022 and 30.1%
in 2025 (Figure 4). The projected number of stunting cases averted among children under 5 years
was ~7 million in 2022 and 9 million in 2025 (Table 1). Appropriate complementary feeding would
avert about 60% of the total stunting cases. Improved water, sanitation, hand washing with soap
and hygienic disposal of children’s stools were other effective interventions which would avert
about a quarter of the stunting cases.
Figure 4: Stunting reduction by scaling-up nutrition interventions (2016-2025)
Table 1: Projected number of stunting cases averted among children under 5 years by type of interventions
Interventions2022 2025
Pregnancy
Calcium supplementation30,400 39,192
Iron supplementation296,196 365,161
Food supplementation during pregnancy71,052 95,491
Infancy
Age-appropriate breastfeeding practices161,247 243,111
Appropriate complementary feeding4,246,409 5,696,655
Vitamin A supplementation93,116 119,892
Rotavirus vaccine935896
WASH
Improved water source11,897 41,209
Improved sanitation450,061 566,394
Hand washing with soap946,808 1,136,549
Hygienic disposal of children’s stools357,052 430,238
Others
Households protected from malaria263,417 339,089
Total6,928,590 9,073,877 26
2.2.1. Stunting reduction: Insights on “how” from State
success stories
Remarkable reduction in stunting was noted in Chhattisgarh, Gujarat, Odisha and Tamil Nadu,
between 2006 and 2016, mostly among older infants (6 months and above). Insights from the
success stories of these States can help understand what factors contributed to stunting declines.
They also help understand how policy and program elements led to changes in high-impact
interventions and determinants.
Changes in immediate determinants were mixed across the four States. The timely introduction
of complementary foods declined in all the States, except Chhattisgarh and the proportion of
undernourished women (with body mass index <18.5 kg/m2) decreased in all four States. There
was consistent improvement in several underlying determinants – household assets, sanitation,
electricity - but to differing extents. The coverage of nutrition and health interventions improved
in all the four States. In the case of Tamil Nadu, along with some improvements in coverage there
were some declines too (Figure 5a and b).
Results of a regression decomposition analysis showed that changes in intervention coverage
and improvements in socio-economic status (SES) were the main contributing factors to changes
in stunting among children (6-59-month-old) in all the four States. In the case of Odisha, village
electrification and in Tamil Nadu maternal education and sanitation also played a role.
The way State policies and programs evolved and innovated was also a notable feature in these
success stories (Figure 6). Major national efforts in the form of ICDS and N(R)HM introduction
and scale-up were complemented by State responsiveness. The four States responded differently
but added State-specific innovations on to the national efforts. The nature and timing of State
innovations and add-ons were also key enablers.
These policy changes were further supported by the individual State’s vision for change and key
le enabling policy environments. Each State had a vision to address an outcome. Chhattisgarh,
being a new State, was geared towards the reduction of infant mortality rate (IMR). In Odisha, the
goal was to reduce both infant and maternal mortality rates (IMR and MMR). Gujarat and Tamil
Nadu were driven by the vision of improving child nutrition and health. The State-level efforts
were sustained by capable and stable administration that was given space and time. There was
adequate financing for the implementation of systems. Stakeholders from various fields, like
media, civil society, human rights commissions, politicians and bureaucrats, acted as catalysts
and champions to support and sustain these positive changes. 27
Figure 5a: Changes in immediate determinants of nutrition in Chhattisgarh, Gujarat,
Odisha & Tamil Nadu (2006-16)
Figure 5b: Factors contributing to changes in height-for-age Z-scores (stunting) among
6-59-month-old children between 2006 and 2016
Source: NFHS-4 analysis
Source: IFPRI study: Stories of Change 28
Figure 6: Evolution and innovation of nutrition-related state-specific policy and program initiatives in
Chhattisgarh, Gujarat, Odisha and Tamil Nadu (2006-16)
ODISHA
CHHATTISGARH
GUJARAT
TAMIL NADU
• Launch of IMR mission (2001)
• Positive deviance approach (Ami bhi paribhu)
• Navajyoti scheme (2005)
• Odisha State Health Mission launched (2005)
• E-pragati (2006)
• Janani express (2008)
• Mo Mashari program (2009)
• Nutrition operation plan (2010)
• MAMATA scheme (2011)
• CMAM initiated (2014)
• State formed in 2000
• Mitanin program launched (2001)
• Public Distribution System reforms (2004)
• Integrated Health and Population Policy (2006)
• Kuposhan Mukhto Abhiyaan (2009)
• Fulwari scheme (2012)
• Vajan Tyohar (2012)
• Nava Jatan Yojana (2012)
• Chiranjeevi Yojana (2005)
• Mobile health units (2005)
• Synchronization of ICDS and health boundaries (2007)
• Nand Ghars (2010)
• Anna Prashan Diwas guidelines released (2010)
• Gujarat State Nutrition Mission (2012)
• Mamta Ghar (2012)
• Gati Sheel Gujarat programme (2014)
• Tamil Nadu Integrated Nutrition Project (1980 – 1997)
• State Plan of Action – child growth and development (1993)
• Kishori Shakti Yojana (2001)
• Pulse polio campaign (1995) – Polio free in 2005
• Malnutrition-free Tamil Nadu –Multi-sectoral strategy (2003)
• Tamil Nadu health systems development project to reach
marginalized and tribal population (2005)
• Dr. Muthulakshmi Reddy Maternity Benefit Scheme (2006)
• Universal PDS
Source: IFPRI study: Stories of Change 29
2.3. What is the potential impact of scaling-up of interventions
on wasting?
The only two interventions available in the LiST tools for estimating the impact on wasting are
treatment of severe acute malnutrition (SAM) and moderate acute malnutrition (MAM). As coverage
data for these two interventions were not collected as part of NFHS-4, the 2016 coverage estimates,
which are treated as the baseline estimates.
While scaling-up MAM treatment to 90% coverage showed significant impact on reducing wasting
from 22% in 2016 to 13.3% in 2022, scaling-up of SAM treatment did not show any marginal impact
on wasting reduction (Figure 7A and Figure 7B). It is possible that SAM treatment would only be
able to move wasted children from SAM to MAM categories, thus would not contribute to overall
reduction in wasting. Given that the World Health Assembly (WHA) target for wasting is at 5% in
2025, additional preventive nutrition and health sensitive strategies are required to achieve further
reductions in wasting to meet WHA target for India.
Figure 7A: Wasting reduction by scaling-up nutrition interventions (2016-2025)
Figure 7B: Projected prevalence of wasting in 2025, by intervention 30
2.4. What is the potential impact of scaling-up of interventions
on anaemia among women of reproductive age
(LiST modelling)?
For anaemia, the numbers and proportions of women with anaemia that could be prevented were
estimated by scaling-up the three key interventions from their most recent coverage level in 2016
to 90% in 2025. These included:
• Coverage of iron supplementation and/or fortification during preconception;
• Coverage of iron or multiple micronutrient supplementation during pregnancy; and
• Coverage of households protected from malaria (percent of households owning at least
one insecticide treated bednet (ITN) and/or protected by indoor residual spraying (IRS).
Coverage data for iron supplementation during preconception period and proportion of households
protected from malaria were not collected as part of NFHS-4 and hence were unavailable for India.
Therefore, these intervention coverage estimates were set to zero at baseline. Baseline coverage
for using iron-folic acid (IFA) during pregnancy in India was 30.3%.
In the LiST model, where coverage of selected interventions was ensured to be at 90% by 2022,
anaemia among pregnant women was projected to decline from 50.3% in 2016 to 34.4% in 2022,
and among women of reproductive age (WRA) it was projected to reduce from 52.9% in 2016 to
39.6% in 2022 (Figure 8a and b). In numbers, this corresponds to ~4 million and 49 million cases of
anaemia prevented among pregnant women and WRA in 2022, respectively. Preconception blanket
iron supplementation/fortification has the highest impact among WRA, and both preconception IFA
and pregnancy IFA supplementation have impact on anaemia reduction among pregnant women.
Given the WHA target of 50% reduction of anaemia in WRA by 2025, India will need to mobilize
other strategies to achieve the WHA target.
Figure 8: Anaemia reduction by scaling-up nutrition interventions (2016-2025)
A. Among pregnant womenB. Among women of reproductive age 31
Summary
For POSHAN Abhiyaan to accelerate impacts on stunting, the LiST modelling re-emphasises the
critical importance of focusing on improving complementary feeding using both behaviour change
interventions and the complementary food supplements in the ICDS as routes. The models predict
that improving complementary feeding is the single most important intervention to help accelerate
reduction in stunting in the future. In addition, other research, including the stunting reduction
success cases in the four selected States, have highlighted the importance of investing in girls
and women (education during childhood, reducing early marriage and early pregnancy, improving
care during and after pregnancy) along with other social determinants for reducing stunting. The
LiST model does not include all these actions, but the collected insights from the LiST modelling
and the success case analyses point in the direction of especially scaling up interventions for
complementary feeding and addressing some critical underlying social determinants.
For wasting reductions, the LiST model suggests that including interventions that go beyond
treatment of SAM to include those that also address moderate wasting, are necessary to
help achieve larger declines in wasting than by tackling SAM alone. Notably, the ICDS already
includes interventions to address moderate malnutrition but the quality and reach of ICDS food
supplements and improvements in the screening and referral are both imperative to ensure that
interventions work as well as they should. The current interventions from the MoHFW, to ensure
in-facility care for SAM children, are currently reaching around 20% of those who are estimated
to need such care. Even as these need expansion, what is imperative is stronger linkages with
community-based programs to reach the large majority of wasted children before they require in-
patient facility care.
For anaemia, the models estimate that a scale-up scenario that focuses only on health sector
interventions will achieve modest improvements in anaemia among women of reproductive age.
Therefore, more attention is needed to other determinants and interventions as well.
Last, but not least, the LiST model, based on MNCH intervention scale-up, tends to underestimate
changes in stunting, compared to wasting. Therefore, it is plausible that stunting gains could be
stronger than those seen in these models. Again, in view of the insights from the successful States
on stunting reduction, it is imperative to consider investments in known social determinants of
stunting along with scaling up interventions. Currently, POSHAN Abhiyaan actions to address
social determinants need to gain momentum alongside a continued focus on scaling up health and
nutrition interventions.
32 33

CHAPTER 3:
PERFORMANCE OF
POSHAN ABHIYAAN
PILLARS AND STATUS
OF DELIVERY
PLATFORMS 34
POSHAN Abhiyaan aims to address malnutrition in a mission-mode through a holistic life-cycle
approach.
3.1. Core pillars of POSHAN Abhiyaan
For implementation of POSHAN Abhiyaan, the core strategy/pillars of the mission are:
• ICDS-CAS (Common Application Software)
• Convergence
• Behavioural change, IEC Advocacy
• Training and Capacity building
• Innovations
• Incentives
• Grievance Redressal.
This report will focus on four pillars of POSHAN Abhiyaan and provide an update on the current
status of activities under the components/pillars of convergence, technology (ICDS-CAS) and
training & capacity building. The details are provided in the following sub-sections. Details of the
Major accomplishment under the POSHAN Abhiyaan are placed as Appendix I and II.
3.1.1. Technology (ICDS-CAS)
POSHAN Abhiyaan introduced ICDS-Common Application Software – an innovative web and
mobile-phone based application to improve service delivery and program management. The
application facilitates Anganwadi workers (AWWs) in their daily tasks, helps supervisors to assess
and provide feedback to the workers, and helps other program officials to track service delivery and
take informed decisions. The ICDS-CAS has three components – a mobile-based application for
AWWs, a mobile-based application for supervisors, and a web-based dashboard for other
program officials.
Figure 9: Pillars of POSHAN Abhiyaan
ICDS-CAS 35
Current status of ICDS-CAS roll-out
According to the POSHAN Abhiyaan monthly progress Report for December 2019 shared by MWCD,
ICDS-CAS has been launched in 27 States and union territories (UTs). Overall, a total of 6,11,369
AWWs and 12,646 supervisors are using this technology, and 9,85,00,183 households have been
registered. A total of 26,56,284 pregnant women, 41,32,763 lactating mothers and 4,74,98,539
children (0-6 years) have been registered.
As seen in Table 1 (Annexure II), of the 27 States/UTs, in 20 of them ICDS-CAS has been rolled out
in all the districts. In Assam, Chhattisgarh, Jharkhand, Madhya Pradesh, Rajasthan, Telangana and
Uttar Pradesh, it has been rolled-out in fewer than 35% of the districts (POSHAN Abhiyaan monthly
progress report December 2019, MWCD).
Of the 27 States/UTs, in 17 States ICDS-CAS has been rolled out in more than 90% Anganwadi
Centers (AWCs), in 8 States in nearly all (>99%) centers, and in Chandigarh, Dadra & Nagar Haveli
and Mizoram in all the centers. In Assam, Chhattisgarh, Jharkhand, Madhya Pradesh, and Uttar
Pradesh fewer than 30% of AWCs have ICDS-CAS (Ministry of Women and Child Development,
2019b).
Procurement process of smartphones for ICDS-CAS is progressing well in most States/UTs.
In 23 States/UTs, 60% or more smartphones, as required for ICDS-CAS, have been procured. In
Karnataka, Odisha, Punjab, and Haryana tender for procurement is in process but no smartphones
have been procured as yet. Only in West Bengal neither there is any procurement, nor has any
tender been placed as yet. Overall, nationwide out of the required 14.94 lakh smartphones for
ICDS-CAS, 7.94 lakh have been procured, which is nearly 50% (Update on Procurement of Smart
Phones and Growth Monitoring Devices May 2020, MWCD).
Similarly, procurement of Growth Monitoring Devices like-Infantometer, Stadiometer, Weighing
Scale (Infants) and Weighing Scale (Mother & Child) is also under process. In 28 States/UTs more
than 60% of Infantometer and in 27 States/UTs more than 60% of Stadiometer are procured; and
in 26 States/UTs more than 60% of Weighing Scale (Infants) and Weighing Scale (Mother & Child)
are procured. Overall, around 65%, 64%, 62% and 65% of Infantometer, Stadiometer, Weighing Scale
(Infants) and Weighing Scale (Mother & Child) are procured, respectively. (Update on Procurement
of Smart Phones and Growth Monitoring Devices May 2020, MWCD).
Setting up of State Program Management Unit (SPMU) at the State level and help desks at the
district and block levels is an important part of ICDS-CAS roll-out. According to the POSHAN
Abhiyaan monthly progress report (Ministry of Women and Child Development, 2019b), of the
35 States/UTs from where data was received
1
, only in Nine States and UTs (A&N Island, Bihar,
Chandigarh, Dadra & Nagar Haveli, Gujarat, Madhya Pradesh, Meghalaya, Mizoram and Rajasthan)
all the sanctioned posts for SPMU were filled and in four States >90% posts were filled. None of the
posts were filled in UT of Ladakh.
District and block-level help desks are the key supporting structures for implementing ICDS-CAS.
There continue to be a high proportion of vacancies at both levels in several States. Only in A&N
Island, Assam, Dadra & Nagar Haveli, Meghalaya, Mizoram, Nagaland, Rajasthan, Telangana and
Uttarakhand all the district and block help desk positions were filled. In Andhra Pradesh, Gujarat,
and Maharashtra while all the district help-desk positions were filled, not all the block positions
within these districts were filled. In 11 States/UTs none of the positions were filled at both the
levels. In the remaining States, there were vacancies at both the district and the block levels
(Ministry of Women and Child Development, 2019b).
1
Data not received from West Bengal 36
Use of ICDS-CAS
The ICDS-CAS roll out can be considered complete when AWWs and their supervisors use their
mobile applications, and the remaining project staff use the web-based dashboard for assessing
service delivery and make data-driven decisions.
The usage of ICDS-CAS by supervisors was varied across the 27 States/UTs. In Chandigarh and
Dadra and Nagar Haveli, all supervisors and in Andhra Pradesh, Gujarat, Himachal Pradesh and
Maharashtra more than 90% supervisors were using ICDS-CAS (Annexure II). In 7 States, less
than 25% supervisors were using ICDS-CAS and in 10 States (Andaman & Nicobar Island, Assam,
Daman & Diu, Delhi, Goa, Kerala, Lakshadweep, Puducherry, Sikkim and Uttarakhand) none of them
were using it (Ministry of Women and Child Development, 2019a).
A process evaluation of the ICDS-CAS, conducted between September 2017 and February 2018 in
Madhya Pradesh and Bihar, showed that a majority of workers preferred the mobile application to
the paper registers (World Bank, n.d.-c).
The training of workers was effective and overall AWWs demonstrated good knowledge of the
application. Nearly 80% of AWWs used the application daily. The AWWs found the application to be
useful in prioritizing home visits, in counselling during home visits, and in plotting growth charts.
The dashboard has undergone design changes to make it user-friendly and to make relevant data
available to improve service delivery. Nearly all AWWs reported at least one challenge in using the
application. These challenges were primarily related to infrastructure – for example, hardware,
application and network issues (World Bank, n.d.-c).
A recent field visit to the World Bank priority States
2
indicated that AWWs were using CAS easily
and have begun using the new module on community-based events. A few areas for strengthening
were identified –
1. Replacement of smartphone: In places where CAS was rolled out during the original phase of the
project, there is a need for phones to be replaced. In some cases, AWWs are using their personal
phones.
2. Use of data: At present, focus is limited to whether the AWCs are open or not and not on service
delivery. Data quality is also not being examined effectively ((World Bank, 2019).
2
World Bank priority States - Andhra Pradesh, Bihar, Chhattisgarh, Jharkhand, Madhya
Pradesh, Maharashtra, Gujarat, Rajasthan, Karnataka, Tamil Nadu, Uttar Pradesh 37
Box 2: State-specific case study on ICDS-CAS
roll-out (Madhya Pradesh)
A process evaluation was conducted by independent evaluators, between September 2017
to February 2018, on ICDS-CAS roll-out in the State of Madhya Pradesh (MP). Some State-
specific results are presented here to provide insights on ICDS-CAS roll-out in MP.
In MP, CAS was implemented without any major impediments. The State’s existing
information technology infrastructure, staff capabilities, motivation to roll-out CAS, and
presence of human resources enabled the roll-out. State-level leadership, governance
aspects of overall ICDS and multiple-partner collaboration were found to be the key
enabling factors for ICDS-CAS roll-out in MP.
Frontline workers’ training: For the ICDS-CAS app training, first LS were trained on the
AWW app and then they trained the AWWs. LS were then trained on the LS app. In terms of
training, all AWWs and LS were satisfied with the training. More than a third of AWWs (34%)
reported receiving refresher training in the 3 months prior to the survey and nearly two-
thirds (64%) expressed the need for further training on the AWW app.
Device and app functionality & helpdesk: A majority of AWWs (81%) contacted LS and more
than half of the AWWs (58%) contacted the helpdesk (BC/DC) for help regarding the issues
they faced with their mobile/app. Of the 27 AWWs who had contacted the helpdesk, 21
reported that their issues were resolved within a week. Only 9 AWWs (19%) faced issues in
reaching out to the authorities regarding mobile or app challenges.
Use of ICDS-CAS app: Around 96% AWWs reported using the AWW app and nearly all of
them used the app daily. Among the 49 AWWs, a majority (85.7%) preferred using mobiles
over registers. Nearly all CDPOs were using dashboard data for analysis, monitoring, and
providing feedback. All DPOs reported monitoring data and providing feedback on them.
However, they shared concerns regarding report generation and data quality.
Impact of ICDS-CAS on service delivery: For 81.6% AWWs home visit planning and growth
monitoring had become easier, and more than 80% reported using videos during home
visits. Nearly half of the AWWs (48.9%) felt that access to data has become easier, and
nearly 47% perceived an improvement in their relationship with the beneficiaries. Of the 50
AWWs in the intervention areas, more than half (58%) reported changes to the planning and
organization of the VHND since the introduction of the ICDS-CAS app.
Impact of ICDS-CAS on utilization of services: More than 70% women in intervention
and comparison areas reported that their children were weighed and nearly 60% reported
receiving information on their child’s growth. More than 90% of women reported receiving
THR in both intervention and comparison areas. Approximately, only one in two women
were aware of VHNDs and only 50% of women attended VHND.
Strengthening ICDS-CAS implementation: Some of the recommendations from this study
to strengthen the implementation of ICDS-CAS in MP include increased investments in
building staff capabilities, and improved hardware capacities (e.g., server space) to support
the app usage. The helpdesk is an important support structure for AWWs and LS in using
the ICDS-CAS app and therefore needs to be fully supported with training, tools, and
staffing. It is important to examine the reasons for AWWs’ and LS’ felt need for periodic
refresher trainings. There is a need to train the State, district, and block ICDS officials on
dashboard and institute a culture of data use for action in the ICDS system.
Source: Avula R., S. Bajaj, P. Pramanik, S. Mani, N. George, L. Gopalakrishnan, N. Diamond-Smith, L. Buback, S. Patil, S.
Nimmagadda, D. Walker, L. Fernald, and P. Menon. 2018. “Integration of the Common Application Software (CAS) into the
Integrated Child Development Services (ICDS) in Madhya Pradesh and Bihar: A process evaluation report”. Unpublished report. 38
3.1.2. Convergence
POSHAN Abhiyaan recognizes the multisectoral nature of the challenge of malnutrition and
identifies convergence as one of its key pillars. The convergence pillar, through the convergent
nutrition action plans at State, district, and block levels, aims to promote coordination and cross-
sectoral efforts involving all important line departments that contribute to nutrition.
POSHAN Abhiyaan sees convergence at two levels:
i) Governance level, which creates institutional mechanisms to ensure coherent response
from multiple departments; and
ii) Impact level where “effective convergence” implies successful reach of programs from
relevant sectors that address the key determinants of undernutrition for the same
household, same woman and same child in the first 1,000 days from conception until the
child’s second birthday.
Current status of convergent action planning
At the governance level, POSHAN Abhiyaan brings about convergence of various nutrition related
schemes by identifying and bringing under one framework all key nutrition related interventions,
indicators and targets to be monitored and achieved by the relevant line ministries/departments
implementing the schemes. Convergence Action Plan (CAP) committees have been constituted to
facilitate the operationalization of this framework.
As of December 2019, 29 out of 36 States/UTs, submitted State-level CAPs for 2019-20. Arunachal
Pradesh, Assam, Jammu & Kashmir, Karnataka, Odisha, Ladakh and West Bengal have not
submitted their CAPs (West Bengal is not on-board at present and Odisha has joined only in
September, 2019). Among the States that have submitted their CAPs, in 21 States, all the districts
have prepared district-level plans and in 22 States all the blocks in all the districts have prepared
their block-level plans ((Ministry of Women and Child Development, 2019b).
Implementation challenges
At the implementation level, after the development of CAPs, 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, during such meetings, there is a lack of focus
and the discussions are generic. Therefore, it is important to identify a core set of indicators that
can be monitored and supported through CAP so that the review meetings become meaningful and
enable them to track progress (World Bank, 2019).
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 children (Institute of Economic Growth 2019).
Need for effective convergence
Although the overarching intent of convergence is clear, the operational guidance does not make it
explicit how stakeholders could ensure that multiple programs reach the same mother–child dyad
in the first 1,000-day period. Given the multiple determinants of malnutrition, to effectively tackle
this problem it is essential that it is approached through a range of inputs across various sectors.
For delivering nutrition-specific and nutrition-sensitive interventions various sectors will need to 39
come together at critical points and in meaningful ways to ensure delivery of key nutrition-related
actions for communities and households (Ved and Menon 2012, IFPRI Discussion Paper).
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. Convergence can only be deemed successful when all interventions reach all target
households in the right timeframes.
The use of empirical analyses, data visualization and sensitization processes to help all
stakeholders identify gaps in effective household convergence is likely necessary to help achieve
the goal of convergent action planning – i.e., that all relevant services and interventions reach
households in the first 1000 days effectively and with high quality. For example, Figure 10 below
highlights that in Andhra Pradesh in 2016, the effective convergence is higher during pregnancy
– with much higher coverage of all key interventions in that life stage – than during infancy/
early childhood, when there are gaps in many different interventions. Gaps in the reach of each
intervention/sector affect the overall household-level convergence of interventions. Strategic
diagnostic work at the district level and State-level are necessary to prioritize what interventions
and actions need the most attention to accelerate coverage, and thereby, close gaps both in
coverage and in effective convergence.
Figure 10: Effective household convergence in Andhra Pradesh: Pregnancy versus postnatal/childhood 40
Convergence, as a process, is most useful, and most effective at the most local level, where
frontline providers can collaborate to ensure adequate service delivery of all necessary
interventions to target client households. Various studies have highlighted how the process of
convergence can be supported (Figure 10). However, co-location of multiple interventions and
actions on the same households in the first 1000 days can likely also be achieved efficiently if all
actors and sectors deliver services independently, but with clear targeting and coverage goals.
“Plan together, act sectorally, review together” has often been a key recommendation for multi-
sectoral programs, however few examples exist of effective and efficient efforts to ensure effective
convergence. This is a critical need to enable this pillar of POSHAN Abhiyaan to deliver on its
outcome goals of reaching all 1000-day households with necessary interventions and services.
3.1.3. Behaviour change communication
Improving nutrition outcomes through strategies of behaviour change communication (BCC) and
community mobilization is an important focus of POSHAN Abhiyaan. For this, Jan Andolan (or
people’s movement) was initiated to carry out media campaigns for awareness generation on 12
key themes
3
using communication materials disseminated through various platforms involving
multiple stakeholders, such as the ministries of health and family welfare, drinking water and
sanitation, school education, rural development, panchayati raj institutions/ village organisations/
self-help groups (SHGs) ensuring wide public participation (World Bank, n.d.-a).
3
Key themes of Jan Andolan: 1. Overall nutrition,2. Breastfeeding, 3. Complementary feeding, 4. Immunization, 5. Growth
monitoring, 6. Food fortification and micronutrients, 7. Diarrhea, 8. Hygiene, water, sanitation, 9. Anaemia, 10. Adolescent
education, diet and age at marriage, 11. Antenatal check-up, 12. Early Childhood Care and Education (ECCE). 41
As a part of social and behaviour change communication (SBCC) under Jan Andolan, in March
2019, Poshan Pakhwada was observed with two-weeks intensive campaign to celebrate the
anniversary of POSHAN Abhiyaan’s launch. Evidence on SBCC was generated from four States
(Andhra Pradesh, Bihar, Gujarat, Madhya Pradesh), in July 2019, to inform the observance of
second Poshan Maah in September 2019, and long-term programming. Of the multiple platforms
used for media campaigns and awareness generation, highest reach was attained by home visit
(81%), television (69%), village health sanitation and nutrition days (66%), community-based events
(60%), and posters, hoardings, or wall paintings (59%). Platforms such as community radio, street
plays and social media had limited reach. The recall rates of messages varied according to the
platform used and was highest for home visits and television (Table 2). The knowledge level and
behaviour practice around complementary feeding and child dietary diversity were found to be low.
It was observed that during counselling, the frontline health workers merely conveyed information
about how to practice behaviors, without explaining the associated rationale and reason (IDinsight,
2019a).
Of the 11 World Bank priority States (mentioned in section 3.1.2.), the annual Jan Andolan plans
of nine States have been approved. Tamil Nadu and Karnataka are yet to develop their plans.
These plans are critical for creating an enabling environment around nutrition-related BCC. From
among the remaining 25 States/UTs, Haryana, Odisha, Telangana have not yet developed their Jan
Andolan plans (World Bank, 2019).
For a targeted and effective BCC, it is therefore important that the right platforms are selected
based on both reach and recall levels. Messages should be targeted towards behaviors that still
have low knowledge or practice levels, like the timely introduction of complementary feeding,
child dietary diversity, and appropriate hand washing practices. It is also important to improve the
quality of nutrition-related messages in community-based events and village health sanitation
and nutrition days. Frontline workers can improve counselling by emphasizing on the rationale and
reason of behaviors. Since poorer and less educated women have less exposure to most SBCC
platforms, frontline workers should prioritize home visits to ensure that nutrition-related messages
reach them (IDinsight, 2019a). 42
Table 2: Platform-wise reach and recall rates
(from IDinsight phase II survey findings, July 2019)
Platform Reach (%) Recall (%)
Health Facility 84 64
Home Visit81 66
Television69 57
Village Health Sanitation Nutrition Day 66 25
Community-based Event60 29
Poster, Hoarding, Wallpainting59 27
Poshan Mela53 15
Growth Monitoring Session49 13
ASHA Mothers’ Meeting44 42
Other Event 40 21
Text Message 39 13
Voice Message39 8
Print Ad 33 39
Audiovisual Van/Camp32 10
Video Shown by FHW32 36
WhatsApp29 22
Nukkad Natak24 8
Facebook21 17
Radio 11 17
Community Radio8 4
Source: Reproduced from POSHAN SBCC Policy Brief 2, IDinsight 2019
High Reach,
High Recall Rate
High Reach,
Low Recall Rate
Very Low Reach,
Very Low Recall Rate 43
Box 3: Jan Aandolan - Poshan Maah 2019
The first 1000 days of a child’s life are most crucial in terms of health and well-being.
Right nutrition interventions lay the foundation of a healthy childhood and rewarding
adolescence and adulthood. With similar leitmotif, Poshan Maah was observed in
September 2019. It aimed to raise the consciousness on the importance of right nutrition
for self, family, community and the country. During Poshan Maah, the efforts to engage with
the community were intensified, as multiple sectors and partners ensured that messages
related to health, nutrition and WASH should reach the masses.
In September 2019, the power of convergent outreach was demonstrated in the activities
of Poshan Maah. They were centered around the key theme of POSHAN KE PANCH SUTRA.
Around 3.6 crore activities across 12 themes were coordinated across the country, where
AWWs, ANMs and ASHAs, along with their helpers and supervisors, came together to
spread the nutrition messages among families and communities.
Poshan Ke Panch Sutra
POSHAN Maah - Convergent Action by Ministries
Themes & Activities
(Source: NITI Aayog) 44
3.1.4. Capacity Building
Capacity building through Incremental Learning Approach (ILA) is a key program pillar under
POSHAN Abhiyaan. The ILA is an innovative learning-by-doing approach. It aims at building the
capacity and motivation of program functionaries. Under ILA, the learning is broken down into
small portions for AWWs. They are oriented on one topic every month, followed by a month of
practice to follow-up on actions. The ILA trainings are given in a cascade manner, from State to
sector level, by the ICDS officials and supervisors (World Bank, n.d.-b).
To implement the ILA training, resource groups are formed at the State, District and Block levels.
These groups and the sub-groups that follow, help to roll-out ILA modules in a standardized and
systematic manner, across all the States. The content of ILA modules focuses on maternal and
child health and nutrition issues. So far, a total of 21 such modules have been developed in Hindi,
English, Marathi and Telugu (World Bank, n.d.-b).
Current status of roll-out of ILA
Of the 21 ILA modules, in Andhra Pradesh, Chandigarh, Dadra & Nagar Haveli, Daman & Diu,
Gujarat, Haryana, Madhya Pradesh, Mizoram, Tamil Nadu all of them were covered at the State-
level (Annexure III). In Arunachal Pradesh, Assam, Jammu & Kashmir, Karnataka, Ladakh,
Lakshadweep, Odisha, Punjab and Telangana, less than 10 modules were covered. In the remaining
States/UTs 10 or more modules were covered. The ILA training has not yet started in West
Bengal (Ministry of Women and Child Development, 2019b). In the 11 World Bank priority States
(mentioned in section 3.1.2.), the ILA rollout is progressing systematically. Across these 11 States,
approximately 7.6 lakh AWWs were oriented on at least one module (World Bank, 2019).
In addition, an online adaptation of the incremental learning modules, known as ‘e-ILA’, has been
launched for both web and mobile-based platforms to complement the face-to-face incremental
learning sessions (World Bank, n.d.-b). All 21 ILA modules are now available in 13 regional
languages on the online platform http://www.e-ila.gov.in(World Bank 2019).
A snapshot of State-wise e-ILA training status among AWWs and lady supervisors (LS) shows
that much needs to be done in most States/UTs (Annexure III). In Andaman & Nicobar Islands,
Assam, Delhi, Goa, Jammu and Kashmir, Meghalaya, Mizoram, Nagaland, Puducherry, Telangana
and Tripura none of the AWWs enrolled for e-ILA have completed their training. However, in Andhra
Pradesh, Daman & Diu, Gujarat and Rajasthan, of the total AWWs enrolled for e-ILA, 80% or more
have completed their training. At the level of LS, in Andaman & Nicobar Islands, Arunachal Pradesh,
Assam, Delhi, Goa, Jammu and Kashmir, Meghalaya, Mizoram, Nagaland, Puducherry, Telangana
and Tripura, none of the LS enrolled for e-ILA have completed their training. Only in Andhra
Pradesh, Gujarat and Rajasthan, of the total LS enrolled for e-ILA, 65% or more have completed
their training (Ministry of Women and Child Development, 2019a).
The delays in the roll out of e-ILA were attributed to delays in the procurement of smartphones for
AWWs and low priority for this modality of training. Only two of the 11 World Bank priority States -
Andhra Pradesh and Gujarat - have reported more than 50% AWWs and supervisors completing all
21 e-ILA modules (World Bank, 2019). 45
Challenges in ILA implementation
To ensure that the ILA trainings are delivered with quality, there are pre-and post- training
assessments as well as visits by the ICDS officials. During the initial implementation of ILA, there
was a dilution in the training quality down the cascade(World Bank, n.d.-b). In the 11 World Bank
priority States, it was found that increasing the frequency of ILA trainings from once per month to
twice a month was compromising the quality of the trainings(World Bank, 2019). However, MWCD
specifies that the periodicity of ILA guidelines were revised for all States/UTs based on the demand
from some States.
To retain the quality of ILA trainings, it is essential to strengthen the systematic monitoring and
supervision of ILA sessions by State, district and block level, and provide clear guidance and tools
to facilitate the same(World Bank, n.d.-b).
In a study conducted across 11 aspirational districts
4
to assess the implementation of ILA
trainings and the resultant AWWs’ practice, the quality of ILA training at the sector level was
observed to be poor. For improvement in quality, it was suggested that sector level training should
be planned such that one training session deals with only one module with smaller batch size. This
will make the training more interactive and effective. Refresher trainings were recommended for
AWWs since a majority of trained AWWs could not demonstrate the steps of growth monitoring, as
observed during this study. To sustain the learning from ILA trainings, it is important that growth
monitoring tools are procured and made available with each AWW. It was also recommended
that the trainings should be conducted by a pool of both government and development partners’
functionaries, under the leadership of State Resource Group (SRG). It is important to enhance the
capacity of government trainers and they should be engaged in training. This study also found that
participation from the health department is limited so far, whereas ILA training guidelines demand
a strong convergence between the departments of health and WCD(Piramal Foundation, 2020).
4
Damoh, Barwani (Madhya Pradesh), Nandurbar (Maharashtra), Pakur, Sahibganj (Jharkhand), Katihar, Sitamarhi (Bihar),
Shrawasti, Chitrakoot (Uttar Pradesh), Jaisalmer, and Baran (Rajasthan) 46
Box 4: Implementation status of POSHAN Abhiyaan in
Rajasthan and Jharkhand
IDinsight conducted a study in 12 selected districts of Jharkhand and Rajasthan to
understand the POSHAN Abhiyaan implementation status. The districts included:
Rajasthan-Ajmer, Baran, Bhilwara, Bikaner, Jhalawar, Jodhpur and Tonk; Jharkhand-
Garwha, Hazaribagh, Khunti, Pakur, Simdega. These districts were broadly representative
of the State and captured the relevant diversity of Rajasthan. Within each of the selected
districts, IDinsight used voter rolls that were updated in December 2019, and built a sample
frame. Then they used a two-stage stratified random sampling method to draw the sample.
The process included approximately 4-6 completed surveys per polling station (≅168 per
district) and covered a total sample size of about 2100 households.
Some of the preliminary findings of implementation status of POSHAN Abhiyaan in
Jharkhand (with Rajasthan comparison):
• Most respondents (59%) registered their pregnancy at the Anganwadi Center during
their first trimester. This is similar to Rajasthan, where 63percent of respondents
registered in the first trimester.
• 29% reported receiving pregnancy-related financial assistance from either Janani
Suraksha Yojana (JSY) or Pradhan Mantri Matritva Vandana Yojana (PMMVY).
For comparison, in Rajasthan, a higher percentage of women reported receiving
pregnancy-related financial assistance (49 percent),
• In Jharkhand, Women reported using the financial assistance on a variety of needs,
with approximately 1/3 of women primarily spending in categories explicitly related
to pregnancy or childcare. But a smaller percentage (33 percent) reported their
primary spending area to be pregnancy- or child child-related in Rajasthan.
• Institutional delivery in the Jharkhand districts is 71%, almost 20% points lower
than in Rajasthan (89%).
• Across both states, only 48% of women received the full schedule of ASHA home
visits.
• The proportion of women receiving ASHA visits as part of Home-Based Newborn
Care in Jharkhand is low, but notably higher than in Rajasthan. 29% received a home
visit within one day of delivery in Jharkhand, compared to 9% in Rajasthan. However
across both States, only 48% of women received the full schedule of ASHA home
visits.
• Early initiation of breastfeeding is more than 70%, across both states.
• Approximately 60% of respondents in Rajasthan initiated complementary feeding
between 6 and 8 months as compared to 52% respondents in Jharkhand.
• Access to supplementary nutrition under ICDS appears to be higher in Jharkhand
than in Rajasthan, though access is still not universal. About 58% of pregnant
women and mothers received take home rations under ICDS for themselves in the
last 30 days, and 49 percent received take home rations for their child. 47
3.2. Core platforms for intervention delivery
POSHAN Abhiyaan’s success rests on the ability to engage and transform core program platforms
in India that can reach households, women and children in the first 1000 days of life. The secore
delivery platforms for these health and nutrition interventions across the country are the Integrated
Child Development Services and the National Health Mission. In this section we examine the State
of these platforms and summarize recent research on what is needed to engage these platforms
effectively to achieve the mission’s objectives.
3.2.1. Integrated Child Development Services
Integrated Child Development Services (ICDS) program, the largest program of its kind in the world,
was initiated by the Government of India in 1975 and universalized in 2008-09. It continues to be
India’s flagship program to tackle undernutrition, and key actions under the POSHAN Abhiyaan
are anchored in this program. It provides food, pre-school education, and primary healthcare to
children under six and pregnant and lactating women.
Reach, coverage, and equity of ICDS interventions, and impact
of the platform
Data from the third and fourth rounds of the National Family Health Survey (2005-06 & 2015-
16), showed a significant increase in the utilization of ICDS services from 2006 to 2016 in four
key areas: supplementary food (9.6 to 37.9%); health and nutrition education (3.2 to 21%); health
check-up (4.5 to 28%); and child-specific services (10.4 to 22%). The frequency of monthly
supplementary food for children also increased during this period by eight percentage points.
However, in 2016, at the national level, less than 60% of women and children received any of the
key ICDS interventions.
• For growth monitoring weight is the most commonly measured (65 percent) across
both the States.
• ORS distribution by a frontline health worker was low in Jharkhand and Rajasthan
(29% and 35%). Household availability of zinc and ORS was also low (only 3% of
households had ORS available and zinc).
• Approximately half of pregnant women and young children were diagnosed with
anaemia in both the States. IFA consumption was higher amongst women (67%)
than children (34%).
• More than 38% of respondents report receiving deworming medicine from any
source in Rajasthan as compared to 32% in Rajasthan. Of the respondents who
attended a National Deworming Day event, around 85 percent received a deworming
pill at that event.
Source: Insights on POSHAN Abhiyaan in Jharkhand and Rajasthan, Preliminary Analysis for NITI Aayog February 2020 48
At the State level, there was an increase in utilization of ICDS services between the two survey
rounds. With the exception of Tamil Nadu, Chhattisgarh and Jharkhand, the coverage of food
supplementation during pregnancy and lactation was less than 25% in most States in 2006, but
increased in almost all States by 2016. The greatest expansion in ICDS services was seen in food
supplementation during childhood, which reached more than 50% coverage in the central and
southern States of Jharkhand, Madhya Pradesh, Uttaranchal, Tamil Nadu and Andhra Pradesh.
However, it was found that both historically disadvantaged castes and pregnant women with
low education levels were less likely to receive ICDS services than other groups. Even though
households in the poorest quintile were better reached by the services in 2016, the wealth
inequality in use widened over the decade. Most of the poor who were left behind were from States
such as Uttar Pradesh and Bihar. Also, there was a high variability in program use, both across and
within States(Chakrabarti et al., 2019).
Facilitators and challenges to service delivery through ICDS platform
In an assessment, the key processes, implementation structure, program monitoring and the
motivations and engagement of the human resources under ICDS were critically reviewed by the
Institute of Economic Growth (IEG). One of the main challenges to service delivery through ICDS
platform is that AWWs, being the village-level point-of-contact for all government schemes, are left
with little time to carry out tasks related to the ICDS. In urban areas, AWWs sometimes also have to
take on the work of ANMs/ASHAs if their post is vacant(Institute of Economic Growth, 2019).
Upgradation of physical infrastructure of AWCs is instrumental to improve program coverage,
uptake and service delivery. There are huge gaps in provisioning of drinking water, toilet facilities
and electricity supply across States/UTs. Since each of the items are dealt by different line
departments, therefore convergent action at the highest level is necessary for universal provision
of these basic facilities(Institute of Economic Growth, 2019).
In terms of finance, the developmental funds available with the gram panchayats (GPs) that can
facilitate the functioning of AWCs do not get used appropriately. For AWC construction-related
problems, it is important that the ICDS budgeting for AWC construction should be sensitive to
regional variations(Institute of Economic Growth, 2019).
There needs to be a change in perception in the district and State administration, regarding
the importance of listening to and solving the problems faced by the frontline workers. With an
increased reliance on digital technology in the ICDS system, frontline workers often experience
difficulties in operating these apps, both due to direct (such as illiteracy) and indirect factors (such
as internet). A strong and functioning feedback mechanism for the AWWs is recommended. Till
this is done, there will be a mismatch between inputs (technology and digital infrastructure) and
outputs (erroneous/incomplete data, deliverables not being met)(Institute of Economic Growth,
2019).
3.2.2. Pradhan Mantri Matru Vandana Yojana (PMMVY)
Since the roll-out of the Scheme (till 31st December, 2019), in total around 1.37 Crores
Beneficiaries have been registered out of which around 87% of the registered beneficiaries have
received 1st installment, 83% registered beneficiaries have received 2nd installment and 56%
registered beneficiaries have received 3rd instalment with cumulative payment of Rs. 4,894 Crore.
The average time taken in payment of 1st installment from the date of registration is around 30
days, however when calculated with respect to the Last Menstrual Period (LMP) the average time
taken is 293 days. Only 17% of the 1st installments have been paid within 150 days with respect to
the date of LMP. 49
The per day registration figure (of new Beneficiaries) has shown a record increase over all previous
quarters, registered around 23,570 beneficiaries per day in the Quarter October-December, 2019.
This is a short of validation to the efforts of MoWCD as they organized the Matru Vandana Saptah
(MVS) from 2nd- 8th December 2019 with various objectives like enrolling new beneficiaries,
increasing awareness about the scheme, clearing backlog cases and clearing correction queue.
65% of the total transfers were made through Aadhaar based payments out of which 67% matched
with the Bank Accounts provided by the Beneficiaries. However, 33% of Aadhaar based payments
(i.e. in case of 69.71 lakh payments) had gone to a different Bank Account than what was provided
by the Beneficiaries, which has substantially increased over last quarters. 50
Box 5: Take-home ration – How to optimize its use?
The supplementary nutrition program (SNP) is one of the six services provided under ICDS.
Within this, the Take Home Rations (THR), provided to pregnant and lactating mothers and
children (6–36 months) is a crucial component of the supplementary nutrition program.
A substantial proportion of the ICDS budgetary allocation is for this component of the
program. Guidelines from the ministry of women and child development (MoWCD) outline
the nutrition norms of THR.
However, as identified in recent research efforts and program experiences, several
challenges remain in ensuring that the ICDS THR is effective in its quality, reach and
impact. To optimize the use of THR, the challenges related to its composition, production,
distribution and consumption by client populations, need to be unravelled and overcome.
Composition & Quality: It is important to give utmost care and attention to the composition
and quality of THR. Evidence suggests that the nutrient content and food composition of
the foods offered within ICDS, specifically foods offered to children 6–36 months of age,
need to be reviewed and revised. Given the variability across India, it is also crucial to test
different formulations of THR or associated commodities, such as eggs, for their ability
to meet the critical nutrient gaps in the diets of infants in ways that also address safety,
palatability, and acceptability (Vaid et al. 2018).
Production of THR: Majority of the States in India have a centralized model for production of
THR. Just in nine States there is a decentralized modality. Looking at the pros and cons of
different THR production modalities, the key opportunities in the centralized model are lower
production cost, high quality product with high nutrient value and quality assurance/quality
control. The challenges of this model include pilferage, leakage, need for efficient transport
arrangements and product acceptability. In the case of decentralized model, procurement of
food from local sources, promotion of income-generation activities, women’s empowerment
and enhanced community ownership are the key opportunities. The challenges of this model
are limited quality control, higher cost of production and challenges with fortification (Review
of Take-Home Rations under the Integrated Child Development Services in India WFP 2019).
Reach and Consumption: It is crucial to look at the reach and use of THR by client
populations. From a survey conducted in 27 districts across 8 States of the Aspirational
Districts Programme (ADP), a 17-pp increase was seen in pregnant and lactating women
(PLWs) receiving any THR. In children 7-36 months old receiving any THR, there was an 11-
pp increase. However, there was no improvement in adequate provision of THR in a month
for both these groups (Round 3 Survey Insights, IDinsight 2019).
Since SNP has a targeted value chain, backed by the State, it has the potential for impact
on nutritional outcomes at scale. There is a scope for public-private partnerships and a
role for private business engagement in improving nutrition outcomes. An examination of
the value chain of SNP under ICDS in the States of Tamil Nadu and Telangana, suggests
innovative pathways for consideration. The State private-cooperative sector partnership
model in Tamil Nadu and a State enterprise dedicated to manufacturing pro-nutrition
agri-foods to address undernutrition through government food distribution programmes
in Telangana, as seen in this study, both have lessons to offer for other States to emulate
and adopt for delivery under the nationally-mandated food distribution program. To
optimize the use of THR, it is essential to take steps in the direction of strengthening its
composition, production, coverage and consumption. 51
Box 6: Growth monitoring
Growth monitoring is a key activity conducted under the Integrated Child Development
Services (ICDS), since it is essential to detect growth faltering and assess nutritional
status. Based on the children’s nutritional status, special supplementary food is given and
/or children are referred for health check-up. Much emphasis is given to the measurement
of children’s height at the Anganwadi Centres (AWCs).
For a systematic surveillance of child growth, it is important to ensure the quality of
growth monitoring data. Given the salience of growth monitoring in POSHAN Abhiyaan
and ICDS program, IFPRI team conducted a multi-State observational study to examine
the growth monitoring process in Bihar, Chhattisgarh, Madhya Pradesh and Uttar Pradesh.
This study did not directly examine the data quality of the growth measures, but observed
growth monitoring process and compared it to the standard anthropometric measurement
guidance.
For weight measurements, study results showed that correct instrument was used for
a majority of children in Chhattisgarh (weighed using baby scale) and Madhya Pradesh
(salter scale). Weighing instruments were placed accurately, or hung from a stable surface,
for more than 90% children in Chhattisgarh, Madhya Pradesh and Uttar Pradesh, but only
for 57% in Bihar. Positioning of the child and layers of clothes on the child during weighing
varied across all four States.
For height measurements, it was observed that the choice of measuring instrument was
flawed for a high proportion of infants, except in Madhya Pradesh. Height measuring
instruments were placed accurately for a majority of children in Chhattisgarh (87%),
Madhya Pradesh (98%) and Bihar (66%). Variable ways were adopted while positioning
children for height measurement. Overall, measuring of height was found to be more flawed
than weighing in all the four States, including choice of instrument and positioning of the
child.
The accuracy of growth monitoring data is very crucial. Along with detecting growth
faltering, it is also used to generate prevalence estimates for stunting, wasting and
underweight. Hence, it is important to consider how inaccurate measures can influence
prevalence estimates using NFHS data. Steps need to be taken to raise awareness about
the quality of growth monitoring process. It is also important to examine the caregivers’
perceptions of the utility of growth monitoring for them.
Source: Bajaj, S., A. Pant, R. Avula, and P. Menon. 2019. “Assessment of the growth monitoring process in the
Integrated Child Development Services program: An observational study conducted across four States in India
(Chhattisgarh, Madhya Pradesh, Bihar and Uttar Pradesh)” Unpublished 52
3.2.3. National Health Mission
The National Health Mission (NHM) is focused on the main programmatic components of
reproductive, maternal, newborn, child and adolescent health (RMNCH+A); health systems
strengthening; non-communicable disease control programs; communicable disease control
program; and infrastructure maintenance. From the NHM platform, Anaemia Mukt Bharat (AMB),
Defeat Diarrhea (D-2), Mother’s Absolute Affection Programme (MAA), immunization, Home-
Based Newborn Care (HBNC) and Home-Based Care of Young Children (HBYC) are some of the
key programs that are being implemented. This report focuses on the roll-out and implementation
of AMB and HBYC and presents an overview of other interventions to understand their reach and
coverage.
A. Status of the roll-out and implementation of Anaemia Mukt Bharat
Under AMB, six key interventions are delivered: prophylactic iron and folic acid supplementation;
deworming; intensified year-round behaviour change communication campaign and delayed
cord clamping in new-borns; testing of anaemia using digital methods and point of care
treatment; mandatory provision of iron and folic acid fortified foods in government funded health
programmes; and addressing non-nutritional causes of anaemia in endemic pockets with special
focus on malaria, hemoglobinopathies and fluorosis. From AMB dashboard
(https://anaemiamuktbharat.info/) data on indicators and relevant resource material on anaemia
can be accessed.
For the coordination of AMB, in all the States/UTs a State-level nodal officer has been designated
for AMB Program Management Unit (PMU). S/he looks after the implementation of AMB through
the existing systems under NHM. There is no provision of constituting a separate State-level AMB
steering committee. Instead, the State level nodal officer reviews the progress.
A comprehensive AMB training tool kit was developed for capacity building of the service providers
and programme managers. First batch of National Training of Trainers was completed, and
State level trainings were initiated. In Bihar, Chhattisgarh, Jharkhand, Madhya Pradesh, Odisha,
Rajasthan, Uttar Pradesh and Uttarakhand, the State resource pool of master trainers was trained
by the National Centre of Excellence and Advanced Research on Anaemia Control (NCEAR-A).
A pan India IFA Supply Chain Diagnostic assessment was completed to identify bottlenecks
in the existing IFA Supply chain. The States which have started procuring 60 mg sugar coated
IFA, against 100 mg and enteric coated tablets, include Assam, Chhattisgarh, Goa, Jharkhand,
Karnataka, Madhya Pradesh, Maharashtra, Meghalaya, Odisha, Rajasthan and Telangana. However,
all the States/UTs have been instructed by MoHFW to continue with the existing stock of 100 mg
IFA till new stocks are available, to ensure uninterrupted supplies under the program. Fourteen
States /UTs have opted for centralised procurement of IFA supplies.
In all the States/UTs, except Andaman & Nicobar Islands, a 2019 State communication/IEC plan
(solid body smart mind) was developed. In only 14 States/UTs the AMB communication package
was printed. These included Andhra Pradesh, Assam, Bihar, Chhattisgarh, Haryana, Jharkhand,
Karnataka, Madhya Pradesh, Maharashtra, Meghalaya, Odisha, Rajasthan, Telangana and Uttar
Pradesh. In all the States/UTs where AMB communication package was printed, it was distributed
to health facilities, ANMs and ASHAs, except in Andhra Pradesh, Meghalaya and Rajasthan. 53
B. Status of the roll-out and implementation of Home-Based Care of
Young Child
Launched in 2018, as an extension of HBNC, the objective of HBYC is to extend community-based
care by ASHA workers till the 15th month of life. Budget was approved for 242 districts (including
aspirational districts) to implement HBYC across all States/UTs, except in Lakshadweep, Goa and
Puducherry. An amount of Rs. 217.68 crore was sanctioned during 2018-19 and 2019-20.
Currently, in 27 States and 5 UTs, there are a total of 28 National Resource Team members (NRTs)
and 166 State-level trainers. Overall, there are 2,050 district-level trainers. In 22 States/UTs a total
of 30,672 frontline workers have been trained. In 21 States/UTs, revised MCP cards have been
provided to all the beneficiaries (instead of HBYC cards). The process is underway in Andaman
and Nicobar Island, Andhra Pradesh, Chandigarh, Dadra & Nagar Haveli, Daman & Diu, Manipur,
Mizoram, Odisha, Puducherry, Sikkim, Telangana, Tripura and Uttar Pradesh. Child-wise tracking
for HBYC program monitoring is done through Reproductive Child Health (RCH) portal
(https://rch.gov.in/).
Coverage and reach of other interventions under National Health Mission
- National Deworming Day (NDD): In August/September 2019, ninth round of NDD was
conducted and 25.5 crore children/adolescents were covered. Tenth round of NDD will
be conducted in February 2020.
- Intensified Diarrhoea Control Fortnight (IDCF) was conducted in June 2019, and further
extended till September 2019 as Defeat Diarrhoea (D-2) campaign. More than 10 crore
under-five children (75%) were covered. Orientation activities for the management
of childhood diarrhea were conducted for 9 lakh ASHAs, 2.1 lakh ANMs and 1.2 lakh
medical officers and staff nurses. To generate awareness among caregivers and
encourage appropriate use, a total of 4,20,949 ORS and Zinc corners were established.
- Under Mothers’ Absolute Affection (MAA) program, capacity building of health workers
on lactation management was done at both community and facility levels. A 360-degree
IEC campaign was conducted to create awareness regarding breastfeeding.
- In 2018-19, around 1.98 lakh children with severe acute malnutrition (SAM) were
admitted in Nutrition Rehabilitation Centres (NRCs). In 2019-20 more than 2.2 lakh
children were admitted in NRCs.
- Immunization: During various phases of Mission Indradhanush, a total of 3.76 Crore
children and 94.6 lakhs pregnant women vaccinated. Under Intensified Mission
Indradhaunsh 2.0, 37.09 lakhs children and 7.41 lakhs pregnant women were vaccinated.
- Newborn week was celebrated in November 2019, where home-based care of newborn
was focused with the involvement of National Neonatology Forum (NNF) and Indian
Academy of Paediatrics (IAP), with support from development partners.
- Social Awareness & Action Plan to Neutralise Pneumonia Successfully (SAANS initiative)
was launched during the best practice summit in November 2019 and a national level
training of trainers was conducted in December 2019. 54
Box 7: Quality monitoring of maternal, infant and young child
nutrition service delivery at village health, sanitation and nutrition days
and community-based events
India has seen some promising improvements in maternal, infant and young child nutrition
(MIYCN) and health outcomes in the past decade. To further accelerate this momentum,
along with various other stakeholders, medical institutions and colleges have a vital role to
play. To tap on this crucial link, a strategic partnership was established among the Indian
Association of Preventive and Social Medicine (IAPSM) and nine government medical
colleges in Uttar Pradesh (UP) and Bihar, under the guidance of NITI Aayog, with support
from Alive & Thrive (A&T). The objective is to strengthen the role of medical colleges
(especially community medicine departments) in supporting State and district health
systems in monitoring and review of public health and nutrition intervention delivery in first
1000 days of life. Some key findings of a quality monitoring exercise on MIYCN service
delivery are presented below, that was undertaken during July–December 2019 in the
catchment districts of Muzaffarpur (Bihar) and Kannauj (UP). Attention was focused on
some critical themes during Village Health, Sanitation and Nutrition Days (VHSNDs), and
Community-Based Events (CBEs), like ‘Annaprashan Diwas’ and ‘Godbharai Diwas’.
Key services and counselling at VHSNDs:
For pregnant women (PW):
- In all VHSNDs, registration of PW & TT vaccination was done; & IFA supplements
provided (when available).
- In 75% of VHSNDs, calcium supplement was provided (when available).
- In 50% of VHSNDs, blood pressure was measured, Hb estimated, & deworming
tablets were provided.
- Services that were lagging included weight measurement, urine examination,
abdominal examination of pregnant women, and counselling on appropriate
weight gain and diet.

For mothers and young children:
- In all VHSNDs, immunization services were provided to young children.
- In 75% of VHSNDs, IYCF messages related to exclusive breastfeeding, continued
breastfeeding during illness and introduction of complementary feeding were
provided.
- In 50% of VHSNDs, weight monitoring and screening for malnutrition was done
and ORS for diarrhoea was provided.
- In 25% of VHSNDs, measured weight was plotted on Mother & Child Protection
card; there was communication on child’s weight and its appropriateness for
age; and ORS for diarrhoea was provided.
- There was no support or communication for addressing breastfeeding
difficulties. 55

Key services and counselling at CBEs:
During ‘Godbharai Diwas’:
- In 75% instances, all eligible pregnant women were mobilized and reached by
AWWs, appropriate IEC materials were displayed, and locally available food items
were available for demonstration.
- In more than 60% of events, diet quantity and diversity for pregnant women were
discussed.
- In 50% of events, functional adult weighing machine was there.
- Only in about 30% instances, proactive engagement and support of husbands
was observed to ensure adequate health & nutrition care of their wives.
- Only 25% of the AWWs had received the stipulated funds (Rs 250/-) for
organizing the event.

During ‘Annaprashan Diwas’:
- In close to 80% of events, functioning weighing scales, reporting formats and
registers were available.
- More than 75% AWWs had maintained updated list of eligible children for the
‘Annaprashan Diwas’ and were mobilizing beneficiaries as per the list.
- In close to 60% of events, counselling was done on child’s weight,
complementary feeding, etc. However, only 14% AWWs used any aids/tools for
counselling and it was suboptimal.

Some of the key barriers that were identified included:
- Women’s inability to attend VHSNDs due to their time poverty.
- Poor education status of PW/mothers.
- Poor compliance to IFA by PW due to metallic taste, side effects.
- Local practice of giving water along with breastmilk.
- Bottle feeding & formula milk prescribed by local practitioners (including
unqualified)
(Source: Quality Monitoring of Public Health and Nutrition Intervention Delivery in the ‘First 1000 Days of Life’ Under the
POSHAN Abhiyaan: Summary Report on Findings from Monitoring Visits July-October 2019)
56
Box 8: Key insights on health outcomes:
Aspirational Districts Programme
Three rounds of surveys were conducted by IDinsight in 27 districts across 8 States for
the Aspirational Districts Programme, between May 2018 and November 2019. Steady
improvements in health outcomes were observed over these three survey rounds. Key
insights from these surveys, in relation to maternal & child care, child feeding & nutrition,
Take Home Ration (THR) program, village health, sanitation & nutrition day (VHSND), child
health services & health seeking behaviors have been presented here.
Maternal and child care
- There was an increase in antenatal care (ANC) registrations (21-pp); and 93%
coverage was achieved. This was accompanied with improvements in the quality
of antenatal care being provided.
- There was improvement in levels of women receiving 4+ ANC check-ups (6-pp).
- There was an increase in institutional deliveries (16-pp)
- Only 57% of below poverty line (BPL) mothers (of children 0-6 months) were
aware of Janani Suraksha Yojana (JSY); only 30% of BPL mothers (of children
0-6 months) who delivered at an institution received financial assistance
under JSY.
- Home-base newborn care (HBNC) was poor; a third of all newborns did not
receive any visit from an ASHA in the first 6 weeks after birth; only 12% of all
newborns received the required number of home visits by an ASHA; maternal
care was not prioritised.
Child nutrition
- There was an increase in early initiation of breastfeeding (21-pp) and exclusive
breastfeeding (4-pp). However, 43% of mothers did not exclusively breastfeed.
- There was a 5-pp improvement in diet adequacy of breastfed children and all
children; but no improvements for non-breastfed children.
- Only 9% of children consumed eggs and only 7% consumed an iron-rich diet
(meat, fish and other flesh foods).

Take Home Ration (THR) program
- There was an increase in pregnant and lactating women (PLWs) registered at the
AWC (7-pp); 85% coverage was achieved.
- There was an increase in PLWs receiving any THR (17-pp), however 38% of PLWs
received no THR.
- There was an increase in children (7-36 months old) registered at the AWCs
(4-pp) and receiving THR in the last month (11-pp); however, 27% children were
still not registered. 57

Village health, sanitation and nutrition day (VHSND)
- There was an increase in the awareness about VHSND (5-pp) and its attendance
(5-pp); however, 60% PLWs were still unaware and 78% PLWs were still not attending.
- In terms of quality, 56% of VHSNDs have all ANC services available; 42% have
distribution of supplementary nutrition; 18% have availability of vitamin A
supplements and 77% have height & weight measurement services available for
children 0-5 years.
Child health services
- ORS treatment and Zinc treatment for diarrhoeal children had stagnated between the
second and third rounds of the survey.
- There was no improvement in levels of children with ARI taken to a health facility.
Health seeking behaviors
- 72% of all adults seeking medical care chose to visit a private health provider
for factors of reputation and distance; only 27% went to a government health
provider. Long waiting time and inconvenient timings were reasons for not visiting a
government health provider.
- 14% of adults did not visit a health provider even when sick; primary reasons were
perceived lack of seriousness of illness & expensive healthcare.
Summary
The success of POSHAN Abhiyaan rests on effective implementation of high-impact interventions
using the core implementation platforms of ICDS and NHM, as well as by engaging other service
providers and all of society through the behaviour change campaigns. Strengthening coverage,
consistency, intensity and quality of interventions, as well as convergence, are key goals, and a
range of systems strengthening efforts have been put in place to help achieve these goals. In this
third report, our assessment covers both the status and roll-out of these systems strengthening
efforts, as well as successes and challenges related to the core platforms of ICDS and NHM –
many of these still require focused attention to help further accelerate intervention coverage and
convergence.
• On the use of technology, i.e., ICDS-CAS, many States must still accelerate procurement
of phones and training of providers and managers. At the same time, insights from the
evaluations of this component indicate that other supportive efforts to scale up the
technology itself also need attention. In each State, specific areas related to the scale-
up of the technology platform need attention. Therefore, a State-by-State assessment,
using the findings of this report, should drive State-specific action to close gaps. 58
• On convergence, much remains to be done. Although the goal of convergence is clear
from the guidance documents, it is apparent from convergence action planning, that
the vision of effective household convergence itself needs translation from national to
district-level stakeholders, and new models for diagnosis, planning and closing of gaps
are needed.
• On behaviour change communication, the campaign mode is well-supported by rounds
of data that now highlight that even though the campaigns are being implemented
effectively, the key platforms to reach households and children in the first 1000 days
remain the routine platforms of home visits, community-based events and mass media.
All other platforms have both lower reach and lower message retention. Thus, efforts
must now double down on extending the reach of the core platforms.
• On capacity building, a range of issues have been highlighted in recent assessments
that suggest that investments in quality of capacity building will need to be a central
goal. This is critical to address the quality component of all POSHAN Abhiyaan
interventions.
• On the ICDS platform, a range of evidence indicates that although the program platforms
have expanded reach, in high burden States, they are still not reaching as many women
and children as they should. Even in Aspirational Districts, overall reach is moving slower
than needed. New research affirms that key governance challenges must be addressed
as they relate to financing, supervision vacancies, infrastructure and more. In addition,
core interventions delivered by the ICDS program such as THR and growth monitoring
need significant quality improvements – these are both core interventions that bring
client populations into the program platforms. These are also important to help
strengthen community-based prevention, detection and treatment of uncomplicated
severe undernutrition and strengthen referrals with the health system for those requiring
in-patient care.
• On the health platforms, a range of efforts are underway to improve the integration of
nutrition interventions into the existing health platforms such as ANC and HBNC and
HBYC. In addition, campaigns such as Anaemia Mukt Bharat are bringing visibility
to issues within the health sector. Ongoing efforts should continue to focus both on
the quality of nutrition interventions in health services and on routinizing/integrating
fully these efforts so as to reduce missed opportunities for service delivery. One key
challenge in the health sector is the use of private care platforms, especially for curative
care, and this will need attention for key interventions such as diarrhea control and use
of zinc.
Overall, further improvements in both the specific systems-strengthening efforts of POSHAN
Abhiyaan, and in the core program platforms for reach of all POSHAN Abhiyaan interventions
are needed. States need to closely assess where they stand both on the specific components of
POSHAN Abhiyaan and on the core platforms and accelerate efforts to close specific gaps. 59

CHAPTER 4:
ADDRESSING MAJOR
CHALLENGES ON THE
ROAD TO A WELL-
NOURISHED INDIA 60
Addressing the complex problem of malnutrition in India is a colossal task that needs a meticulous
and multi-pronged approach. Through implementing POSHAN Abhiyaan, the Government aims to
reduce child stunting, underweight and low birth weight by 2 percentage points per annum and
anaemia among children (and young females) by 3 percentage points per annum. However, to do
so, as the LiST modelling in Chapter 2 highlights, actions to improve complementary feeding are
going to be among the most important actions to help reduce stunting. In addition, new findings
from the Comprehensive National Nutrition Survey (CNNS 2016-18) have highlighted again the role
of micronutrient malnutrition - anaemia and other micronutrient deficiencies - are new major areas
of challenge. Last, but not least, the changing context of India is one of increasing urbanization, an
issue that is receiving attention in terms of its salience for development but where solutions are
still limited.
In this chapter, therefore, we discuss the lingering challenge of complementary feeding, as well as
the new insights on micronutrient malnutrition and the cross-cutting issue of urbanization as a
set of focus issues that need to be addressed in a targeted manner to achieve the targets set by
POSHAN Abhiyaan.
4.1. Complementary feeding
Complementary feeding interventions are usually targeted at the age range of 6-24 months,
because feeding practices over these first few crucial months of a child’s life can critically
influence development. Evidence shows the significant impacts of complementary feeding
interventions on children’s growth, morbidity, development, micronutrient intake and micronutrient
status (Dewey & Adu-Afarwuah, 2008). Evidence also highlights associations between feeding
practices and growth and neurodevelopmental outcomes at 36 months of age among children
from low- and low-middle-income countries and emphasizes the importance of adequate food
quantity and quality (Do et al., 2018). Last, but not least, in this report, we highlight using the LiST
model how improving complementary feeding by scaling up existing evidence-based interventions
is critical to help achieve the stunting targets of POSHAN Abhiyaan. Therefore, complementary
feeding interventions that are effective at reducing malnutrition during this vulnerable period
should be a high priority.
4.1.1. Status
Complementary foods should be introduced to infants at 6 months of age, and from then onwards,
infants and young children need to be fed a diverse set of foods, frequently during the day and in
enough quantities so as to achieve a high quality diet that contributes to additional nutrients over
and above what infants and young children get from continued breastfeeding. A set of accepted
indicators are used to assess the extent to which these practices are adequate at the population
level. We summarize insights on these below.
• Timely introduction at 6 months: According to the results of the Comprehensive
National Nutrition Survey (CNNS 2016-18), there was timely introduction of
complementary food for over half (53%) of the children (6 to 8 months), as compared to
45% as reported in NFHS-4 (Figure. 11). A higher proportion (59%) of children residing
in urban areas were given complementary foods from six months of age, compared
to their rural counterparts (51%). The proportion of children who were introduced to
complementary food in a timely manner, increased with household wealth, from 42% in
the lowest wealth quintile to 68% in the highest wealth quintile. In cases where women 61
had no schooling, only 37% of 6-8 months children were introduced to complementary
food on time whereas if women had completed 12 years of schooling, then 67% of 6-8
months children were introduced to it.
• Quality, frequency and adequacy of complementary foods: We examine three
complementary feeding indicators that together, bring together insights on the dietary
quality, frequency, and overall adequacy of complementary feeding - minimum dietary
diversity, minimum meal frequency, and minimum acceptable diet. According to CNNS
results (2016-18), 42% of children aged 6 to 23 months were fed minimum number of
times per day for their age, whereas according to NFHS-4 the minimum meal frequency
for this age group was reported to be slightly lower (36%). Both CNNS (2016-18)
and NFHS-4 results show that only 21% of children aged 6 to 23 months were fed an
adequately diverse diet containing four or more food groups. The CNNS suggests that
fewer children (6-23 months) consumed iron-rich food (8.5%) compared to the NFHS-4
(22.5%) (Figure. 11).
Complementary feeding varies tremendously by State. In Meghalaya, Sikkim and Kerala, a high
proportion of children aged 6 to 23 months received a minimally diverse diet whereas in Jharkhand,
Rajasthan and Andhra Pradesh a lower proportion received it (Annexure IV). The proportion of 6-23
months children receiving at least as many meals as recommended for their age was highest in
Sikkim (67.4%), Kerala (65.9%) and Tripura (62.5%) and lowest in Andhra Pradesh (22%), Punjab
(22.4%) and Goa (23%) (Annexure IV). The highest percentage of children (6-23 months) in Sikkim,
Kerala and Arunachal Pradesh received minimum acceptable diet, whereas it was the lowest in
Andhra Pradesh, Maharashtra and Mizoram (Annexure IV). In Meghalaya, Manipur and Sikkim a
greater proportion of children consumed iron-rich foods; the lowest proportion were in Haryana,
Rajasthan, Gujarat, Madhya Pradesh and Punjab (Annexure IV).
Figure 11: Trends in infant and young child feeding practices in India 62
4.1.2. Recommendations for key actions
Meeting the nutritional needs of children aged 6 to 23 months can be particularly challenging
in resource poor settings. Complementary feeding practices for children 6–23 months old in
South Asia are far from optimal (Aguayo, 2017). Complementary foods for children aged 6–23
months are primarily cereal‐based diets and are lacking in the essential growth‐promoting
nutrients provided by fruits and vegetables (only 1 in 3 children 6–23 months old is fed fruits and
vegetables) and foods of animal origin (less than 1 in 5 children is fed meat, fish, poultry, and/or
eggs). This is of great concern given the high levels of child stunting in South Asia (Aguayo, 2017).
India has a supportive policy environment to improve infant and young child feeding (IYCF)
interventions and multiple operational platforms exist that can deliver counselling and
complementary food supplements. India’s policies are well aligned with the scientific evidence on
what it takes to improve complementary feeding – i.e., counselling interventions for food-secure
populations and counselling combined with food or cash transfers for food-insecure populations
(Avula et al., 2017). The ICDS program includes provision both for counselling and for food
supplements, and the new efforts by the MoHFW around the Home-Based Young Child program
include provisions for counselling; finally, the Jan Andolan can play a key role in broadening the
conversations around complementary feeding. However, the reach of these programs is not as
widespread as it should be, especially in the States with the highest burden of stunting and the
poorest complementary feeding practices (Map 1 and Map 2). In addition, although we know that
the reach of the ICDS THR is variable across States and districts, we know less about the quality,
uptake and use of this major component of the program’s interventions to improve complementary
feeding.
Map 1: Percentage of women with children under five years of age who received health and
nutrition education/counselling during lactation, by district, 2016
Source: NFHS-4 (2016). 63
Map 2: Percentage of children (6-35 months) who received food supplements, by district, 2016
To further scale-up interventions to improve infant and young child feeding in India, it is
recommended that:
• Content on complementary feeding in existing counselling and behaviour change
interventions needs to be focused, salient and sharp
o In the ICDS, health and nutrition education via interpersonal counselling to lactating
women should address complementary feeding, and counselling services to mothers
in the context of growth monitoring and home visits needs to be strengthened to
address complementary feeding robustly.
o In services offered by MoHFW, specific aspects of complementary feeding that can
be addressed or reinforced by the home visits under the HBYC program should be
strengthened
o Community-based events and mass media should be used to expand coverage and
reach of messages on complementary feeding
• Composition and quality of food in the form of THR and Hot-Cooked meals to be
examined clearly
o Re-examine current guidelines on composition and quality of food in the ICDS
program.
• To scale up both counselling and complementary food supplements, the following need
attention
o Substantial gaps need to be closed to ensure higher contact of interpersonal
counselling between frontline workers and 1000-day households, especially in high
population States. ICDS-CAS and other coverage/reach monitoring approaches can
help with this.
Source: NFHS-4 (2016). 64
o Systems challenges related to capacity, finance, and governance need to be
addressed, prioritizing those geographies where the greatest numbers are currently
being left out.
• To generate evidence rapidly on what can work in the Indian context
o Formative research to understand what constraints families are facing in feeding
their infants and young children appropriate complementary foods is essential; this
is what will help tailor locally salient strategies across India.
o Specific aspects of counselling and complementary food supplement interventions
need to be tested urgently.
Overall, investments in program innovations, in learning and evaluation, financing research, and
strengthening of governance of existing programs to support complementary feeding are needed
to support the scale‐up of high‐impact interventions to improve IYCF in India.
 
4.2. Anaemia
Anaemia, a condition marked by low haemoglobin (Hb) concentration, affects approximately 2.36
billion individuals globally, and India carries its largest burden. Even though anaemia declined in
India between 2006 and 2016, it remained highly prevalent in children and pregnant women.
4.2.1. Status
Anaemia is highly prevalence among India’s youth, affecting 41% of 1-4-year olds, 24% of 5-9-year
olds, and 28% of 10-19-year olds (Figure 12). Anaemia prevalence is highest in central and eastern
States, iron deficiency is highest in western States across the entire north-south range. This
underscores the complex etiology of anaemia and suggests that addressing iron deficiency will not
solve India’s anaemia problem. More work is needed to better understand the relative contribution
of causal factors to the overall anaemia burden in the country.
Figure 12: Anaemia among children & adolescents
1
, India, CNNS 65
1
WHO guidelines for hemoglobin (Hb) concentrations for the diagnosis of anaemia in children
and adolescents were used. Hb levels were adjusted for altitude in areas >1000 meters. Hb levels
referred to diagnose anaemia among children and adolescents are: a.) Children aged 1-4 years
- Hb level < 11g/dl; b) Children aged 5-11 years – Hb level < 11.5 g/dl; c) Adolescents aged 12-
14 years – Hb level < 12.0 g/dl; d) Adolescent girls aged 15-19 years – Hb level < 12.0 g/dl; e)
Adolescent boys aged 15-19 years – Hb level < 13.0 g/dl
 
4.2.2. Recommendations for key actions
Public health strategies to prevent and control anaemia generally include a suite of interventions
targeted across the life cycle:
• During pre-pregnancy and pregnancy: iron and folic acid supplementation (Map 6),
deworming (Map 7), and malaria prevention strategies.
• In newborns, infants and in early childhood: delayed cord clamping, exclusive
breastfeeding for infants, iron and folic acid supplementation (Map 8), and deworming
(Map 9).
• Across the life-course: fortification or biofortification of staple foods with micronutrients,
consumption of diverse diets that include sources of iron and other micronutrients.
• Addressing social determinants such as water and sanitation, education, and poverty
alleviation.
As seen in the maps of intervention coverage, the reach of key interventions already in India’s
programs was highly variable in 2016. Further insights are needed on how coverage may have
changed in the context of the policy emphasis offered by the Anaemia Mukt Bharat. A key use of
NFHS-5 will be to examine changes in coverage and reach of some of these programs between
2016 and 2019-20.
In addition to existing health sector programs, nutrition-sensitive interventions (Nguyen et al.,
2018) and school-based interventions (Adelman et al., 2019) may be opportunities for India,
particularly given the nearly universal enrolment and massive safety nets that exist in the country.
However, any intervention requires behavior change. Changing social norms has been a constant
challenge for uptake of iron folic acid supplements and other interventions that require behaviour
change. Research is underway to inform policymakers about the value of adopting a socio-
normative approach to anaemia reduction (Sedlander et al., 2018).
For India, the CNNS data show that anaemia affects youth of all ages. The 6x6x6 strategy of
Anaemia Mukt Bharat (AMB) is a positive step and is ambitious in its goal to reduce the prevalence
of anaemia by three percentage points per year. The Government of India has also included staple
food fortification (including rice fortification) as part of its comprehensive strategy to address
anaemia in multiple States, including Andhra Pradesh, Gujarat and Karnataka (PATH, 2019).
Although internal monitoring of supply-side interventions (e.g. IFA and deworming) is in place,
the success of AMB in the long run would be best measured using an experimental or quasi-
experimental approach. 66
4.3. Micronutrient deficiencies [1 to 19-year-old population only]
Micronutrient deficiency is a major challenge in India, affected both by diet quality and
inflammation/infection. A multipronged approach is needed to address deficiencies of key
vitamins and minerals, such as vitamin A, iron, iodine and zinc, that continue to coexist and
interact with protein and energy deficits (NITI Aayog, n.d.). In an academic review focused on the
current scenario of micronutrients’ status in the country (anaemia, vitamin A, iodine, vitamin B12,
folate, ferritin, zinc, copper and vitamin C), Gonmei and Toteja have emphasized that deficiencies
related to iron, vitamin A, iodine and zinc are of high public health importance among children and
adolescents (Gonmei & Toteja, 2012). Recent research also points to the significance of folate,
vitamin B12 and vitamin D in maternal and child health.
Global evidence suggests that micronutrient deficiencies are an important cause of morbidity and
mortality, accounting for a considerable loss of Disability Adjusted Life Years (DALYs), especially
in infants and pre-school children. Micronutrients deficiencies among children can also lead to
impaired cognitive development, poor physical growth, increased morbidity and decreased work
productivity in adulthood (WHO, 2009). In this report we will look at the prevalence of vitamins A, D,
B-12, folate and zinc deficiencies among 1 to 19-year-old children in India.
4.3.1. Status
Vitamin A deficiency
According to the CNNS results (2016-18), 22% school-age children (5–9-year-olds) were vitamin
A deficient, as compared to 18% pre-school children (1–4-year-olds) and 16% adolescents
(10–19-year-olds). State-wise data shows that among 1-4-year-old children, in Goa only 2% had
vitamin A deficiency, whereas in Jharkhand nearly 43% children in this age group were vitamin A
deficient, which is a serious public health concern. Among 5–9-year-olds, vitamin A deficiency was
most prevalent in Mizoram (47%), and among adolescents (10–19 years) it was most prevalent in
Jharkhand (30%) and is considered a serious public health problem (Figure 13).
Vitamin D deficiency
Vitamin D deficiency was noted to be lower among pre-school children (14% in 1–4-year-olds),
as compared to school-going children (18% in 5–9-year-olds) and adolescents (24% in 10–19-
year-olds) (CNNS results 2016-18). In the States of Punjab, Uttarakhand and Manipur, vitamin D
deficiency was particularly high among children of all age groups (Figure 13).
Vitamin B-12 & folate deficiencies
Data from CNNS 2016-18 show that vitamin B-12 deficiency was higher among adolescents aged
10–19 years (31%) as compared to school-age children aged 5–9 years (17%) and pre-school
children aged 1–4 years (14%). A similar pattern was noted for folate deficiency; 37% among
10-19-year-olds, 28% among 5–9-year-olds, and 23% among 1-4-year-olds. State-wise analysis
shows that vitamin B-12 deficiency was highest in Gujarat among children aged 1–4 years (29%)
and adolescents aged 10–19 years (48%); whereas for children aged 5–9 years it was highest
in Punjab (32%). In Kerala and West Bengal, prevalence of vitamin B-12 deficiency was lowest.
Folate deficiency was found to be highest in Nagaland among children aged 1–4 years (74%) 67
and adolescents aged 10–19 years (89%); whereas for children aged 5–9 years it was highest
in Andhra Pradesh (69%). In Sikkim and West Bengal, prevalence of folate deficiency was lowest
(Figure 14).

Zinc deficiency
According to CNNS results (2016-18), zinc deficiency was found in nearly one-third of adolescents
aged 10–19 years (32%). Fewer pre-school children aged 1–4 years (19%) and school-age children
aged 5–9 years (17%) were found to be zinc deficient. In Himachal Pradesh zinc deficiency is
a serious concern; 41% of pre-school children (1-4-year-olds) and 38% of school-age children
(5-9-year-olds) were found to be zinc deficient. States with a high burden of zinc deficiency among
adolescents (10–19-year-olds) were Gujarat (55%), Manipur (53%), Himachal Pradesh and Punjab
(both 52%) (Figure 13).
1
For Vitamin A deficiency diagnoses, WHO guidelines were used. Children aged 1–9 years and
adolescents aged 10-19 years old were defined to have Vitamin A deficiency if serum retinol
concentration in blood was <20 μg/dL.
2
For Vitamin D deficiency cut-offs, Institute of Medicine (IOM) guidelines were used. Children aged
1–9 years and adolescents aged 10-19 years old were defined to have Vitamin D deficiency if the
concentration of serum 25(OH)D was <12ng/mL (30 nmol/L).
3
For Zinc deficiency cut-offs, International Zinc Nutrition Consultative Group guidelines were used.
Children aged 1–9 years were defined to have Zinc deficiency if serum zinc concentration was <
65 μg/dl. Adolescents aged 10-19 years old were defined to have define Zinc deficiency if serum
zinc concentration was < 70 μg/dl (morning fasting) and < 66 μg/dl (morning non-fasting) in non-
pregnant girls and < 74 μg/dl (morning fasting) and < 70 μg/dl (morning non-fasting) in boys.
Figure 13: Percentage of adolescents with Vitamin A
1
, Vitamin D
2
, and Zinc deficiency
3
, India, CNNS 68
 
1
For Vitamin B12 deficiency diagnoses, WHO guidelines were used. Children aged 1–9 years and
adolescents aged 10-19 years old were defined to have Vitamin B12 deficiency if serum Vitamin
B12 was <203pg/ml.
2
For folate deficiency diagnoses, WHO guidelines were used. Children aged 1–9 years and
adolescents aged 10-19 years old were defined to have folate deficiency if the concentration of
serum erythrocyte folate was <151ng/mL.
4.3.2. Recommendations for key actions
The most commonly used strategies to control micronutrient deficiency are supplementation and
fortification, because they are cost-effective and relatively easy to deliver. However, little emphasis
has been placed on food-based approaches to address micronutrient malnutrition. To improve
dietary quality for poor populations, more interactions are needed among the nutrition, agriculture
and development communities (Allen, 2003). Inadequate dietary intake is also dependent on
inadequate household food insecurity. Hence it is necessary to focus attention on improving
household food security. It is also necessary to address other contributing factors of micronutrient
deficiencies, like poverty, lack of purchasing power and limited knowledge about appropriate
nutritional practices (Khan & Bhutta, 2010).
In the context of India, micronutrient deficiencies are being addressed under the Anaemia
Mukt Bharat initiative through the provision of iron and folic acid (IFA) fortified foods and IFA
supplements. There are directives from central ministries for schemes/programs such as ICDS,
MDM and PDS about the fortification of five staples - wheat flour, rice, oil, milk, and salt. In
addition, the new initiatives such as the Bharat Poshan Kisan Kosh, led by the MWCD, will shed
more light on local strategies for diversifying diets.
Key recommendations to improve and strengthen actions on addressing micronutrient
deficiencies, which emerged at a vision-setting exercise, with the consensus of key nutrition
stakeholders, include the following (International Food Policy Research Institute & NITI Aayog,
2019):
Figure 14: Percentage of adolescents with Vitamin B12
1
and Folate
2
deficiency, India, CNNS 69
• Address data needs on outcomes, determinants and on food consumption:
o Bring together all micronutrient-related data, tools, aids, etc. in a single accessible
space for convenience and enhanced usage.
o Ensure that deep—dive nutrition surveys may be conducted every 3-5 years to
generate adequate data on micronutrient malnutrition outcomes and determinants.
• Use a range of behaviour change strategies to increase awareness and make better and
more diverse diets and better nutrition itself aspirational
• Improve policy guidance, policy coordination and monitoring of existing programs on
supplementation and fortification:
o Have guidelines on areas, like diet diversification, multiple micronutrient
supplementation (MMS) and folic acid supplementation.
o Increase the micronutrient content of staples delivered through ICDS, MDM, PDS
either through fortification or biofortification.
o Have policies to make fortification mandatory.
o Appoint an expert in micronutrient deficiencies at the State-level as the key contact
person.
o Strengthen the capacity of service providers and manufacturers to address
micronutrient deficiencies.
o Standardize monitoring mechanisms for micronutrient interventions across States
and have common targets.
o Strengthen the quality monitoring of fortified products that reach the consumers and
vulnerable groups in particular:
o Assess and strengthen the capacity of national and State level laboratories
for micronutrient testing and train regulatory personnel on appropriate
sample collection, testing and related protocols.
o Develop appropriate quality monitoring data at State and national levels.
• Invest in addressing food systems issues to ensure diet diversity:
o Increase the production, availability and accessibility of diversified food
commodities across the country with the full-scale engagement of
agriculture and food & civil supplies sectors.
o Assess and strengthen policies to address the prices of healthy foods to
address the affordability issues of nutritious food.

4.4. Emerging cross-cutting challenges
With changes in the income and lifestyle of populations, both globally and in India, there is a rapid
shift in the diet patterns and average caloric intake of people. While undernutrition continues to
demand attention, there is a significant rise in obesity/overweight, non-communicable diseases and
micronutrient deficiencies. A number of inter-related factors are driving these emerging challenges. 70
4.4.1. Urbanization
Urban population is expanding worldwide. With it, the burden of malnutrition, in the form of child
undernutrition, persistent micronutrient deficiencies, and rising overweight and obesity, has shifted
from rural areas to cities. Globally, the proportion of stunted children living in urban areas rose
from 23 to 31%—meaning that approximately one in three stunted children now lives in an urban
area. Overweight and obesity, at the global level, have also risen rapidly in both children and adults.
The number of overweight children rose by more than 50% in 20 years (1990– 2011). Limited
access to healthcare, safe water, and sanitation in cities leads to severe health and nutrition
inequalities for the urban poor—especially slum dwellers. The urban poor face a challenging food
environment too. Extremely poor urban households in many developing countries spend more than
half their budget on food (Ruel et al., 2017).
In a fast-growing economy like India, every year about 7.5 million population is added to urban
areas (Kumar and Saiyed 2019). An analysis of nutrition outcomes in urban versus rural areas,
among children (0-59 months old), showed that in 2016 the proportions of stunting (30% vs 38%),
underweight (30% vs 38%), and wasting (22% vs 24%) were not hugely different (Figure 15). A
similar analysis among adolescent girls (15-19-year-old) and women (15-49-year-old), showed
that anaemia among adolescent girls was above 50% in both urban and rural areas and the gap
between them was small, but low BMI was significantly higher among girls from urban areas (44%
vs 38%). The prevalence of obesity was almost two times higher among women from urban areas
compared to those living in rural areas (31% vs 15%) (Figure 16).
Urban areas performed better than rural areas for most immediate determinants of nutrition,
except exclusive breastfeeding. However, both in urban and rural areas, very low percentage of
children receive the minimum acceptable diet (11% in urban and 9% in rural) (Figure 15). Among
underlying determinants, women’s literacy, schooling and marriage age were higher in urban areas
compared to rural areas. At the household-level, more than 95% urban and 83% rural households
were electrified. Open defecation was much larger in rural areas (more than 50%).
In terms of coverage of interventions, during pregnancy 21% women in urban areas received
deworming medicine as compared to 16% in rural areas. Women in urban areas received less
food supplements, health and nutrition education and counselling than rural areas (37% vs 60%)).
More than 90% of women in urban areas had an institutional delivery by skilled birth attendant.
Compared to rural, lesser urban women received food supplements and health and nutrition
education during lactation period.
A new approach is required to tackle the complex and complicated urban health scenario. National
Urban Health Mission (NUHM), which was launched in 2013, systematically works towards
meeting the regulatory, reformatory, and developmental public health priorities. However, there is
huge shortage of primary healthcare services in the urban areas. There is a need to expand the
scope of primary care to preventive and promotive healthcare services along with curative (Kumar
& Saiyed, 2019). 71
*** p-value < 0.001, ** p-value <0.01, * p-value <0.10
Note: All indicators except anaemia were calculated among children aged 0-59 months. Indicator
for anaemia was calculated among children in the age group 6-59 months.
Figure 16: Prevalence of nutrition outcomes among adolescent girls (15-19-year-old) and women
(15-49-year-old), by place of residence, NFHS-4 2016
*** p-value < 0.001, ** p-value <0.01, * p-value <0.10
Figure 15: Prevalence of nutrition outcomes among children (0-59 months old),
by place of residence, NFHS-4 2016 72
Figure 17: Prevalence of immediate determinants of nutrition, by place of residence, NFHS-4 2016
*** p-value < 0.001, ** p-value <0.01, * p-value <0.10
Note: Exclusive breastfeeding was computed among infants aged 0-6 months, timely introduction
of complementary foods was computed among infants aged 6-8 months, minimum acceptable
diet, minimum dietary diversity, and minimum meal frequency was computed among children aged
6-23 months. Indicators of experiencing ARI symptoms and diarrhoea were computed among
children 0-59 months old.
 
4.4.2. Overweight, non-communicable diseases and the .food environment
Evidence shows that, like many other low and middle-income countries (LMICs), India is facing a
dual burden of undernutrition and overweight/obesity. Between 2006 and 2016, the prevalence of
overweight/obesity among adult women increased from 15.1% to 24.1% and among adolescents
from 3.0% to 5.2% (Young et al., 2019). Almost 1 in 5 men and women were identified with body
mass index greater than 25 kg/m2, which is a sign of overweight. From NFHS-4 data, it was clear
that districts with the highest levels of overweight/obesity were located in Punjab, southern States
of India as well as coastal part of Goa, Maharashtra and Gujarat. Some urban districts in Andhra
Pradesh were on top of the list of districts with the highest prevalence of overweight/obesity
among women (Punima Menon et al., 2017).
In terms of non-communicable diseases, close to 14% of men and 10% of women in India were
identified with high blood pressure according to the NFHS-4 survey. In a majority of districts
across India, over 1 in 10 men were diagnosed with high blood pressure. In 121 districts, mostly
concentrated in the north-east, parts of south and some districts in the north-west, 1 in 5 men had
high blood pressure. The proportion of women with high blood pressure was lower as compared
to men. On average, 8% of men and 6% of women had high blood sugar level (above 140 mg/dl),
with considerable variability across districts. The districts with prevalence of high blood sugar
among men were mostly in the southern parts of India, and the eastern and western coastal areas,
including Gujarat, West Bengal, and the north-east (Punima Menon et al., 2017). 73
Studies show that rapid changes in the food system, particularly the availability of cheap ultra-
processed food and beverages in LMICs, and major reductions in physical activity at work,
transportation, home, and even leisure due to introductions of activity-saving technologies, are
widely responsible for growing challenge of overweight and non-communicable diseases (Popkin
et al., 2020). Hence it is important to look at the drivers of food choices and overall adopt a
systems perspective that can help in developing effective policies for agriculture, food and nutrition
(International Food Policy Research Institute & NITI Aayog, 2019). Double-duty actions, which aim
to simultaneously tackle both undernutrition and problems of overweight, obesity, and diet-related
non-communicable diseases, will be needed. Double-duty actions are based on the rationale that
all forms of malnutrition share common drivers that can be leveraged for double impact. These
drivers include early life nutrition, diet diversity, food environments, and socioeconomic factors.
Putting a double-duty approach into operation involves assessing the potential harm of existing
actions and redesigning programmes and policies with a focus on double-duty actions. Changes
in governance, financing, and capacity building will be needed to put the approach to use
(Hawkes et al., 2020).
Summary
Solving the malnutrition challenge in India requires that the nutrition policy and program
community work both on some lingering deep and old challenges, as well as on keeping pace
with new and emerging challenges. In this chapter, we have focused in on two lingering, but
deep challenges, and a set of emerging challenges that need foresight, experimentation and new
thinking to ensure that robust actions can be put in place.
On lingering critical challenges, we highlight first the importance of investing in improving
complementary feeding, focusing on key interventions in existing program platforms. Our main
recommendations are to ensure strong linkages between the counselling and the take home
rations in the ICDS and ensure that together, they reach all households with a child under two.
Why? Because together, these two interventions provide a package of known evidence-based
interventions for vulnerable, food insecure households. Specifically, the following actions are
critical:
(1) Improve the composition and invest in ensuring that everything is done to increase
the reach and quality of the take home rations
(2) Ensure that the behaviour change counselling reaches every family that has a child
in the first two years of life, using existing frontline worker platforms and all available
platforms to create a buzz of awareness.
(3) Address the systems challenges that are currently preventing adequate reach and
quality of counselling services, in particular
The second lingering challenge is that of anaemia. India has had programs to address anaemia
for decades now. These programs have been only partially successful. The Anaemia Mukt Bharat,
however, offers a new impetus to strengthen, focus and amplify work to address anaemia.
However, much more is needed to scale-up and strengthen some of the existing interventions in
the health system – micronutrient supplements, deworming, prevention and treatment of malaria.
In addition, the other focus actions of the AMB mission require acceleration, as do the social
determinants of anaemia. 74
On the new challenges outlined in this chapter – newly identified micronutrient deficiencies,
and the cross-cutting challenges of urbanization and of emerging overweight and obesity – our
primary recommendation is to first acknowledge that these new findings need attention. At the
same time, challenges like single micronutrient deficiencies do not require single micronutrient
solutions. Deeply investing in improving dietary quality – through a primary focus on dietary
diversity and diet quality – will help achieve multiple nutrition goals. In addition, following the
path already laid out on fortification of key staples will help mitigate, at least partially, some
micronutrient deficiencies. Urban food systems and food environments pose new challenges,
as does urban health service delivery. In both food and health systems in urban contexts,
engaging private health care providers and a range of actors who can help create healthier food
environments for a range of consumers is going be essential. The focus of work on urban nutrition
must go well beyond catering to the challenges of the urban poor and must engage stakeholders
across the board.
Last, but not least, the challenge of overweight, obesity and non-communicable diseases must
be confronted. It is a force to reckon with and without full-scale and dedicated attention and
action, it will be too late. Tackling these challenges requires also tackling the food and physical
environments in homes, workplaces and institutions. Existing movements like the Eat Right and Fit
India movements must be connected strongly with the POSHAN Abhiyaan mission of improving
diets for all stakeholders. 75

CHAPTER 5:
LOOKING AHEAD
FOR TRANSFORMI NG
NUTRITION IN INDIA 76
The Government of India is committed to improving the nutritional status of children, adolescents,
pregnant women and lactating mothers through POSHAN Abhiyaan. Adopting a life-cycle
approach, POSHAN Abhiyaan is well positioned to transform the nutritional status of India. Resting
on the key pillars of technology, multisectoral convergence, behavioral change and capacity
buildings, it aims to ensure that intensified health and nutrition services are delivered from the core
platforms, and its specific nutrition targets are met over the next few years. To strengthen POSHAN
Abhiyaan for improving key nutrition outcomes, the following recommendations have been made
on the basis of progress and challenges, as documented in this report.
5.1. Recommendations for accelerating current trends in
addressing key undernutrition goals
To assess how POSHAN Abhiyaan can accelerate current trends in addressing its key
undernutrition goals, particularly for stunting, wasting and anaemia, a Lived Saved Tool (LiST)
modelling analysis was done in this report. Insights were also drawn from an in-depth
retrospective mixed method analysis of selected States that had successfully accelerated
stunting reductions, especially in the decade between 2006 and 2016. Some of the specific
recommendations that emerged are as follows:

Stunting
For POSHAN Abhiyaan, the LiST modelling emphasised the critical importance of focusing
on improving complementary feeding using both behaviour change interventions and the
complementary food supplements in ICDS, as routes to reducing stunting. The model predicted
that improving complementary feeding is the single most important intervention to help accelerate
stunting reduction in the future. In addition, other research, including the stunting reduction
success cases in selected States, highlighted the importance of investments in girls and women
(education during childhood, reducing early marriage and early pregnancy, improving care during
and after pregnancy) along with other social determinants for reducing stunting.

Wasting
For wasting reduction, the LiST model suggested that including interventions that go beyond the
treatment of severe acute malnutrition (SAM) to include those that also address moderate wasting,
have the potential to help achieve larger declines in wasting than by tackling SAM alone. Notably,
the ICDS already includes interventions to address moderate malnutrition but the quality and reach
of ICDS food and improvements in the screening and referral are both imperative to ensure that
interventions work as well as they should.

Anaemia
The LiST model estimated that a scale-up scenario that focuses only on health sector
interventions will achieve modest improvements in anaemia among women of reproductive age.
Therefore, more attention is needed on other determinants and interventions as well. 77
5.2. Recommendations for strengthening key POSHAN
Abhiyaan pillars
Technology
With the introduction of ICDS-Common Application Software (ICDS-CAS), POSHAN Abhiyaan
intends to improve service delivery and program management through an innovative web and
mobile-phone based application. On the use of technology, it is evident from the report that many
States still need to accelerate the procurement of phones and training of providers and managers.
At the same time, insights from the evaluations of this component indicate that other supportive
efforts to scale-up technology itself also need attention. In each State, specific areas related to the
scale-up of technology platform need attention. Therefore, a State-by-State assessment, using the
findings of this report, should drive State-specific action to close gaps.
Convergence
POSHAN Abhiyaan recognizes the multisectoral nature of the challenge of malnutrition and
identifies convergence as one of its key pillars. From the progress so far, however, much remains
to be done on convergence. Although the goal of convergence – i.e., that programs and services
converge on all households in the first 1000 days - is clear from the guidance documents, this is
not as clear in the planning of actions. A critical need is that the core vision of effective household
convergence be translated from national to district-level stakeholders, and that models for
diagnosis, planning and closing of gaps in convergence be tested.
The success of POSHAN Abhiyaan’s convergent action planning efforts lies in the ability of the
convergence-related processes to trigger the within- and across-sector actions that lead
to the effective reach of an agreed upon core set of interventions to all households in the
1,000-day period. The use of empirical analyses, data visualization and sensitization processes
are recommended to help all stakeholders identify gaps in effective household convergence and
ensure that all relevant services and interventions reach households in the first 1,000 days -
effectively and with high quality.

Behavioral change
Improving nutrition outcomes through strategies of behaviour change communication and
community mobilization is an important focus of POSHAN Abhiyaan. On behavior change
communication, the campaign mode is well-supported by rounds of data that now highlight
that even though the campaigns are being implemented effectively, the key platforms to reach
households and children in the first 1,000 days remain the routine platforms of home visits,
supplemented by community-based events and mass media. All other platforms have both lower
reach and lower message retention. Thus, efforts must double down on extending the reach of
the core platforms, especially of home visits. This is especially critical for home-based behaviours
such as complementary feeding.

Capacity building
Capacity building through Incremental Learning Approach (ILA) is a key program pillar under
POSHAN Abhiyaan. On capacity building, a range of issues have been highlighted in recent 78
assessments that suggest that investments in the quality of capacity building will need to
be a central goal. This is critical to address the quality component of all POSHAN Abhiyaan
interventions. Since the delays in the roll out of e-ILA were attributed to delays in the procurement
of smartphones for AWWs and low priority for this modality of training, it is essential that the
procurement process of smartphones is expedited, and the training is prioritized. Priority areas for
capacity building include strengthening the quality of growth monitoring and the quality of
home-based counselling.
5.3. Recommendations for interventions delivery through core
platforms (ICDS & NHM)
POSHAN Abhiyaan’s success rests on the ability to engage and transform core program platforms
of ICDS and NHM, such that the health and nutrition interventions can reach households, women
and children in the first 1,000 days of life. Strengthening the coverage, consistency, intensity and
quality of health and nutrition interventions that are delivered from the core platforms of ICDS
and NHM is a key goal of POSHAN Abhiyaan, and a range of systems strengthening efforts have
been put in place to achieve it. From the assessment of the status and roll-out of these systems
strengthening efforts, as well as successes and challenges related to the core platforms of ICDS
and NHM, it is apparent that many of these still require focused attention, as recommended below:

ICDS platform
On the ICDS platform, a range of evidence indicate that although the program platforms have
expanded their reach, in high burden States, they are still not reaching as many women and
children as they should. Even in Aspirational Districts, the overall reach is moving slower than
needed. New research affirms that key governance challenges must be addressed as they relate to
financing, supervision vacancies, infrastructure and more. In addition, core interventions delivered
by the ICDS program, such as THR and growth monitoring, need significant quality improvements
– these are both core interventions that bring client populations into the program platforms.
NHM platform
On the NHM platform, a range of efforts are underway to improve the integration of nutrition
interventions into the existing health platforms such as ANC, HBNC and HBYC. In addition,
campaigns such as Anaemia Mukt Bharat are bringing visibility to issues within the health sector.
Ongoing efforts should continue to focus both on the quality of nutrition interventions in health
services and on routinizing/integrating fully these efforts to reduce missed opportunities for
service delivery. A key challenge in the health sector is the use of private care platforms, especially
for curative care, and this will need attention for key interventions, such as diarrhea control and
use of zinc.
Overall, further improvements in both the specific systems-strengthening efforts of POSHAN
Abhiyaan, and in the core program platforms for reach of all POSHAN Abhiyaan interventions
are needed. States need to closely assess where they stand, both on the specific components of
POSHAN Abhiyaan and on the core platforms and accelerate efforts to close specific gaps. 79
5.4. Addressing challenges (old and new) for transforming
nutrition in India
Solving the malnutrition challenge in India requires that the nutrition policy and program
community work both on some lingering deep and old challenges, as well as on keeping pace with
new and emerging challenges. For emerging challenges, foresight, experimentation and new ways
of thinking are required to ensure that robust actions can be put in place.

Complementary feeding
To address some of the lingering challenges of undernutrition, it is important to invest in improving
complementary feeding and focus on key interventions in existing program platforms. One of the
main recommendations is to ensure strong linkages between counselling and take-home rations
in ICDS and ensure that they reach all the households with a child below two years. It is very
significant because together, these two interventions provide a package of known evidence-based
interventions for vulnerable and food insecure households. Specifically, the following actions are
critical:
1. Improve the composition and invest in ensuring that everything is done to increase the
reach and quality of the take-home rations.
2. Ensure that the behavior change counselling reaches every family that has a child in the
first two years of life, using existing frontline worker platforms and all available platforms
to create a buzz of awareness.
3. Address the systems challenges that are currently preventing adequate reach and
quality of counselling services, in particular.

Anaemia and other micronutrient deficiencies
Anaemia is also a lingering challenge in India, despite having programs for decades to address it.
These programs have been only partially successful. The recently launched Anaemia Mukt Bharat
(AMB) offers a new impetus to strengthen, focus and amplify work to address anaemia. However,
much more is needed to scale-up and strengthen some of the existing interventions in the
health system, like micronutrient supplements, deworming, prevention and treatment of malaria.
In addition, the other focus actions of the AMB mission require acceleration, as do the social
determinants of anaemia (as shown by LiST analysis).
New analysis highlight that a range of micronutrient deficiencies are a challenge too. Some of
these also affect outcomes such as anaemia. We note that single micronutrient deficiencies do
not require single micronutrient solutions. Deeply investing in improving dietary quality in rural and
urban India and for all age groups – through a primary focus on dietary diversity via food systems
– will help achieve multiple nutrition goals. In addition, following the path already laid out on
fortification of key staples will help mitigate, at least partially, some micronutrient deficiencies.

Urbanization and overweight/obesity
To address cross-cutting challenges of urbanization and of growing overweight and obesity, our
primary recommendation is to first acknowledge that the new findings, as documented in this
report, need attention. 80
Urban food systems and food environments pose new challenges, as does urban health service
delivery. In both food and health systems in urban contexts, engaging private health care providers
and a range of actors who can help create healthier food environments for a range of consumers
is going be essential. The focus of work on urban nutrition must go well beyond catering to the
challenges of the urban poor and must engage stakeholders across the board.
Last, but not least, the challenge of overweight, obesity and non-communicable diseases must
be confronted. It is a force to reckon with and without full-scale and dedicated attention and
action, it will be too late. Tackling these challenges requires also tackling the food and physical
environments in homes, workplaces and institutions. Existing movements like the Eat Right and Fit
India movements must be connected strongly with the POSHAN Abhiyaan’s mission of improving
diets for all stakeholders.
These recommendations are expected to navigate and further strengthen the ongoing actions
under POSHAN Abhiyaan. It is evident that there is no single magic bullet. However, with a
systems perspective and multisectoral approach, high-impact interventions need to be effectively
implemented with the synergistic engagement of stakeholders from various sectors and an overall
involvement of the society. With all of the above in place, POSHAN Abhiyaan will continue to play a
pivotal role in transforming India’s nutritional status.
81

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ANNEXURES 86
Model FeaturesAdvantagesDisadvantages Sources
Lives
Saved Tool
(LiST)
It is a computer-based
modelling tool that can
be used to estimate the
impact of scaling up
health and nutrition inter-
ventions on maternal and
child health outcomes. It
can estimate reduction in
mortality due to change in
the coverage of interven-
tions.
1. Ability to look at the
impact of multiple inter-
ventions aimed to improve
maternal, newborn and
child health. It covers sev-
eral interventions (more
than 70 maternal, newborn
and child health and nutri-
tion interventions), which
can be modelled individu-
ally or in combination.
2.LiST’s complementa-
ry tools can be used to
model on a sub-national
basis; produce costing
estimates; and generate
‘missed opportunities’ to
show where the coverage
is low and could poten-
tially be maximized for
increasing the number of
lives saved.
3. Evidence based.
4. Validated and pub-
lished.
5. Regularly updated and
maintained.
6. Free and available in
public domain.
1. Depends on data
availability and
quality.
2. Does not deter-
mine whether cover-
age scale up targets
are feasible (in terms
of acceptability and
cost).
3. Interventions
must be feasible in
low-middle income
countries, otherwise
they can’t be includ-
ed in the model.
https://academic.oup.com/jn/
article/147/11/2132S/4743210
https://www.ncbi.nlm.nih.gov/
pmc/articles/PMC3847271/
cle/147/11/2132S/4743210
OptifoodIt is an optimization tool
that can be used to inform
(and test) food-based
recommendations, for
behavior change pro-
gramming; to assess
nutritional adequacy of
local food environments;
and to determine
affordability of a nutri-
tious diet for specific tar-
get groups at the individ-
ual (not household) level.
Optifood models can also
identify ‘problem nutri-
ents’ (i.e. those whose
requirements are diffi-
cult to meet using local
foods), and the most
expensive nutrients and
food sources in a given
diet. It provides informa-
tion on products (such as
fortified foods or micro-
nutrient powders) that
could be added to the
local diet to result in an
adequate diet.
1. It has a broad scope in
terms of coverage. One
can select and evaluate
food-based recommenda-
tions (FBR) for any group
(by age, sex, life stage) in
any country.
2. There is flexibility in
operation. Country specific
reference nutrient intake
(RNI) and food composi-
tion data can be used in
the analyses; and from the
list of nutrients users can
select the RNIs that they
would like to model.
3. Once the model param-
eters are set-up, the model
can be run quickly.
4. All model parameters
are locked after setting
them up. This ensures
comparability across all
module outputs.
Does not model im-
pact on malnutrition
outcomes.
https://www.nyas.orng/me-
dia/19786/optifood.pdf
https://www.spring-nutrition.
org/publications/tool-summa-
ries/optifood
Annexure I
Review of Nutrition Modelling Tool 87
Model FeaturesAdvantagesDisadvantages Sources
Optima
Nutrition
It is a mathematical
modelling tool that
assists users to allocate
most recent or projected
budgets across a range
of nutrition-specific (e.g.
vitamin supplementation)
and nutrition-sensitive
(e.g. family planning) pro-
grams. It conducts alloca-
tive efficiency analyses
and projects trends in
malnutrition under differ-
ent intervention coverage
or funding scenarios.
1. Can provide quantitative
evidence for the prioritiza-
tion of nutrition programs
in the context of limited
funding. The model can
also assist in the develop-
ment of investment cases
and national planning.
2. Data required is easily
available.
3. The model has a
flexible intervention set
that includes a variety of
interventions.
1.The model is heav-
ily influenced by the
effect size estimates
of each program,
which are obtained
from the sparse (but
growing) academic
literature and are not
always setting-spe-
cific.
2. Analyses also
require estimates on
the costs of scaling
up interventions,
which have inherent
uncertainty.
3. Data intensive.
4. It is not an estab-
lished model, still
new.
5. Not designed to
determine alloca-
tions between differ-
ent diseases.
https://bmcpublichealth.
biomedcentral.com/arti-
cles/10.1186/s12889-018-
5294-z
https://www.nyas.org/me-
dia/19779/optima-nutrition.pdf
http://optimamodel.com/
docs/Optima%20Nutrition%20
User%20Guide%20Feb2019.pdf
Cost of the
Diet
It is an optimization tool
that analyzes the amount,
combination, and cost
of local foods needed
to provide families with
a nutritious diet. The
software uses linear pro-
gramming to find optimal
combinations of available
foods that meet energy,
macronutrient, and micro-
nutrient needs.
1. Can estimate the min-
imum cost of a local-
ly-specified diet at both
individual and household
levels.
2. Considers seasonal
variation in prices when
costing the diet.
3. Identifies nutrients for
which it may be hard to
meet requirements.
4.Software is easy to use,
and not very data inten-
sive.
Does not model im-
pact on malnutrition
outcomes.
https://www.securenutrition.
org/resource/cost-diet-tool-v2
https://www.spring-nutrition.
org/publications/tool-summa-
ries/cost-diet
Intake
Model-
ling and
Prediction
Program
(IMAPP)
IMAPP looks at the
current consumption
patterns of certain foods
that might be used as ‘ve-
hicles’ for fortification and
provides the user with the
optimal amount of a nu-
trient to add for a targeted
prevalence of inadequacy.
It estimates how much
nutrient one needs to
add to a food vehicle to
achieve that prevalence.
It is an optimization tool
that operates at the
level of the individual and-
calculates what is needed
to ‘close the nutrient gap’.
1. It can estimate the
population at risk of
inadequate or excessive
intakes.
2. Usable by almost any-
one (i.e. dietary assess-
ment knowledge is not
necessary).
Does not model im-
pact on malnutrition
outcomes.
https://www.nyas.org/me-
dia/20840/nutritionmodelin-
greport-final-21june2017-up-
dated-logo.pdf 88
Model FeaturesAdvantagesDisadvantages Sources
ProfilesIt is a spreadsheet-based
nutrition advocacy tool
used to calculate conse-
quences if
malnutrition does not
improve or change over a
defined time period and
the benefits of
improved nutrition over
the same time period,
including lives saved,
disabilities averted,
human capital gains, and
economic productivity
gains.
1. Addresses a range of
different nutrition prob-
lems individually.
2. Is flexible and allows
the user to choose the
specific nutrition problem
they would like it to deal
with.
3. Is imbedded in a broad-
er advocacy process in the
country.
Does not model im-
pact on malnutrition
outcomes.
https://www.fantaproject.org/
sites/default/files/resources/
Nutrition-Advocacy-PRO-
FILES-Manual-Apr2018_0.pdf
https://www.nyas.org/me-
dia/20840/nutritionmodelin-
greport-final-21june2017-up-
dated-logo.pdf
MINIMOD It is a mathematical mod-
elling tool that
can identify cost-effec-
tive solutions to specific
micronutrient-related
problems. It provides
estimates of the impacts
of alternative micronutri-
ent intervention programs
and their combinations (in
collaboration with LiST),
costs of micronutrient in-
tervention programs and
their combinations and
identifies the least-cost
method for achieving a
pre-specified micronutri -
ent objective, or, the max-
imum impact for a given
budgetary constraint.
1.Addresses a range of
different nutrition prob-
lems individually.
2. Is flexible and allows
the user to choose the
specific nutrition problem
they would like it to deal
with.
3. Is imbedded in a broad-
er advocacy process in the
country.
1. Flexible framework: A
broad array of national
and subnational policy
scenarios can be devel-
oped.
2. Robust.
3. Multiple indicators of
impact.
4. Multiple beneficiary
groups.
5. Multi-program focus.
6. Multi-year timeframe.
1. The nutrition ben-
efits model requires
detailed, nationally
representative data
on dietary intakes
and biomarkers.
2.Relatively high lev-
els of technical ex-
pertise are required
to run the nutrition
benefits and eco -
nomic optimization
models.
3.Limited to only
micronutrient de-
ficiency outcomes
(other malnutrition
outcomes such as
stunting, wasting not
covered).
https://www.nyas.org/me-
dia/19782/minimod.pdf
Nutrition
Interna-
tional
MMS Cost
Benefit
Tool
It is designed to help
governments to deter-
mine health benefits and
budget impact of transi-
tioning from iron and folic
acid supplementation
(IFAS) to multiple micro-
nutrient supplementation
(MMS) in their maternal
health programs.
1. Novel in concept: Re-
cent evidence has encour-
aged low-middle income
countries to consider
transitioning from long
standing IFAS to MMS,
however, global guidance
to facilitate this transition
is limited.
2. Simple to use yet pro-
vides meaningful results.
Does not model im-
pact on malnutrition
outcomes.
https://www.nyas.org/me-
dia/19782/minimod.pdf
https://www.nutritionintl.org/
content/user_files/2019/10/
MMS-cost-benefit-tool-user-
guide-2019-10-09-final-web.
pdf 89
Annexure II
Table 1: State-wise overview of ICDS-CAS roll-out and usage
S. No.States / UTs District roll-out %AWCs roll-out %% of supervisor
using ICSD-CAS
1 Andaman & Nicobar 10099.31 0
2 Andhra Pradesh10099.9699
3 Assam27.3 20.130
4 Bihar10082.4911
5 Chandigarh100100100
6 Chhattisgarh25.9 19.9621
7 Dadra & Nagar Haveli 100100 100
8 Daman & Diu10095.33 0
9 Delhi10091.620
10 Goa10096.280
11 Gujarat10099.96 95
12 Himachal Pradesh10099.70 99
13 Jharkhand29.2 29.1415
14 Kerala10099.380
15 Lakshadweep10062.620
16 Madhya Pradesh31.4 28.6314
17 Maharashtra10099.23 95
18 Meghalaya10098.90 81
19 Mizoram100100 52
20 Nagaland10093.72 67
21 Puducherry10099.180
22 Rajasthan27.3 33.85 20
23 Sikkim10062.770
24 Tamil Nadu10099.95 67
25 Telangana32.3 31.2512
26 Uttar Pradesh33.3 27.27 4
27 Uttarakhand10097.520
Source: Information based on POSHAN Abhiyaan monthly progress report, December 2019, MWCD
<25% 25-<50%50-<75% 75% 90
Annexure III
Table 2: State-wise coverage of ILA modules & e-ILA training status
S. No. States / UTs
ILA modulese-ILA training
Coverage at
state-
level (out of total
21 modules)
% of enrolled
AWWs
who have
completed
e-ILA training
% of enrolled lady
supervisors who
have completed
e-ILA training
1Andaman & Nicobar Islands 1-1300
2Andhra Pradesh 1-21 86.38 77.19
3Arunachal Pradesh 1-6 0.190
4Assam1-6 & 8 00
5Bihar 1-15 0.03 1.67
6Chandigarh1-21 75.78 55.56
7Chhattisgarh1-16 18.17 19.31
8Dadra & Nagar Haveli 1-21 72.94 18.18
9Daman & Diu1-21 80.3920
10Delhi 1-18 (except 8)0
11Goa 1-1000
12Gujarat 1-21 97.80 96.22
13Haryana 1-21
14Himachal Pradesh 1-15 5.47 5.52
15Jammu and Kashmir 1-600.00
16Jharkhand 1-16 2.41 10.50
17Karnataka1-6 & 8
18Kerala 1-12
19Lakshadweep 1-6
20Madhya Pradesh 1-21 19.86 15.48
21Maharashtra 1-17 28.17 16.90
22Manipur 1-13 (Except 8)
23Meghalaya 1-1900
24Mizoram 1-2100
25Nagaland 1-1900
26Odisha 1-6
27Puducherry 1-1600
28Punjab1- 6 & 8
29Rajasthan1-16 87.13 65.92
30Sikkim 1-19
31Tamil Nadu 1-21 42.31 25.00
32Telangana1-6 & 8 00
33Tripura 1-1800
34Uttar Pradesh 1-21 (Except 8) 5.11 7.30
35Uttarakhand 1-19 0.75 0.78
36West BengalNot yet started
Source: Information based on POSHAN Abhiyaan monthly progress report, December 2019, MWCD
<25% 25-<50%50-<75% 75% 91
Annexure IV
Figure 2: Minimum dietary diversity 92
Figure 3: Minimum meal frequency 93
Figure 4: Minimum acceptable diet 94
Figure 5: Consumption of iron rich foods 95

APPENDIX 1 96
Appendix-I
Major accomplishment under the POSHAN Abhiyaan
1. National Nutrition Mission (POSHAN Abhiyaan) was approved on 18th December,
2017 for a three year time frame commencing from 2017-18 with an overall budget of
`9,046.17 Crore. Except West Bengal, all the States/ UTs have started activities under
POSHAN Abhiyaan. Odisha has decided to join the Abhiyaan only in September, 2019 and
has started rolling out of activities.
2 Major Steps taken for effective roll-out of POSHAN Abhiyaan during the period is as under :
2.1.1 Hon’ble Speaker, Lok Sabha, graciously accepted inclusion of the matter “POSHAN
Abhiyaan” for discussion on 2nd August, 2019 during Zero Hour in the House and
reiterated that all of us need to join hands in the mission.
2.1.2 Hon’ble Prime Minister has talked about POSHAN Abhiyaan during his ‘Mann Ki Baat’
programme on 25th August, 2019 in which he has stated that under the POSHAN
Abhiyaan campaign, nutrition made available with the help of modern scientific
methods is being converted into a mass movement all over the country. People are
fighting a battle against malnutrition in innovative and interesting ways.
2.1.3 Bharatiya Poshan Krishi Kosh (BPKK): On 18th November, 2019 MWCD announced
an innovative project in partnership with the Bill & Melinda Gates Foundation named
the “Bharatiya Poshan Krishi Kosh”. The “Kosh” will be a repository of diverse crops
across 127 agro-climatic zones in India for better nutritional outcomes and aims
to make India nutrition secure. Traditional dietary practices and Social Behaviour
Change Communication Messages around them will also be documented as a part of
the project.
2.1.4 Hon’ble Vice President Shri M Venkaiah Naidu had launched the ‘Bharatiya Poshan
Anthem’ in New Delhi on 3rd December, 2019, which aims to inspire people to join the
movement to fight the scourge of malnutrition. The Anthem has been written by Sh
Prasoon Joshi and composed and sung by Sh Sankar Mahadevan.
2.1.5 As per the directions of Hon’ble Speaker of Lok Sabha, MWCD has prepared diet charts
for pregnant women in collaboration with the National Institute of Nutrition, Hyderabad
for six different regions of the country.
2.2 Steps taken for effective monitoring and expediting progress: Following steps are
taken by MWCD for effective monitoring of POSHAN Abhiyaan activities and expediting
progress:
2.2.1 A number of Orientation workshops have been held at Central level, States/UTs.
Series of Video Conferences have also been held under the Chairmanship of Secretary,
MWCD.
2.2.2 Constant review and monitoring of activities at all levels is being done. 97
2.2.3 Top leadership in the States is being associated with the POSHAN Abhiyaan. In the
last ten months, Hon’ble Minister, Women & Child Development has reviewed the
progress of POSHAN Abhiyaan with the Chief Ministers of 16 States in which apart
from the senior officers of Ministry, representatives of Ministry of Health & Family
Welfare and NITI Aayog also participated.
2.2.4 Secretary, MWCD has also reviewed the progress of POSHAN Abhiyaan with the Chief
Secretaries of the States during his visits to the States. Video Conferences are also held
on regular intervals with State Secretaries for speedy implementation of all the activities.
2.2.5 Letters are bein regularly written by the Secretary, MWCD to the Chief Secretaries
of Sates/UTs drawing their attention to the performance of the States/UTs under
POSHAN Abhiyaan and requesting them to review the POSHAN Abhiyaan regularly.
2.2.6 District Magistrates are also involved in POSHAN Abhiyaan activities through Video
Conferences and WhatsApp Group.
2.2.7 Ministry also participated in the Common Review Mission with MoHFW for Joint
Review of NHM and POSHAN Abhiyaan to facilitate better convergence at all levels.
2.2.8 Visits of the Officers of the Ministry to the States/UTs regularly.
2.2.9 National Council under the Chairmanship of Vice Chairman, NITI Aayog and the
Executive Committee under the Chairmanship of Secretary, Ministry of Women &
Child Development (MWCD) also monitor the progress of POSHAN Abhiyaan. During
the period one meeting of Executive Committee and one meeting of National Council
held.
2.2.10 A National Conference was organised on 13th and 14th November, 2019 with State/
UT Secretaries of Women and Child Development for in-depth review of POSHAN
Abhiyaan and other Schemes.
2.2.11 The Ministry of Women and Child Development established a call centre under
POSHAN Abhiyaan. A toll-free number ‘14408’ is allocated to Ministry of WCD for
POSHAN Abhiyaan Helpline. The Call Centre is enabled with both Inbound & Outbound
calls. Call Centre is operated multi-lingual and its expansion is synchronised with
Roll-out of ICDS-CAS Application. A total number of 33.17 Lakh outbound calls have
been made to the frontline workers and beneficiaries up to March, 2020.
2.2.12 A Calendar of the year 2020 covering Poshan Ke Panch Sutra was prepared and
disseminated to Members of Parliament, Ministries/Departments, partners etc.
2.2.13 A joint implementation support Mission (JISM) was also organised during 16-20
December, 2019. The objectives of the Joint JISM were to: (i) review implementation
progress of the POSHAN Abhiyaan, (ii) review progress and achievement against
agreed Disbursement Linked Indicators targets in 11 priority states, (iii) facilitate
cross-learning amongst states through inter-state field visits during the mission; (iv)
discuss technical support in different areas of POSHAN Abhiyaan; and (v) identify
bottlenecks in implementation and agree on next steps and priorities moving forward.
Filed visits were also undertaken as part of JISM.
2.2.14 National Stakeholder Consultation with Development Partners, Line Ministries/
Departments and States/UTs on identifying Promising Dietary Practices for Social &
Behavioral Change Communications (SBCC) strategies and Jan Andolan in partnership
with Harvard T.H. Chan held on 21st January, 24th January and 28th January, 2020. 98
2. Components of POSHAN Abhiyaan and update are as under:
2.1 Human Resources: A National Nutrition Resource Centre–Central Project
Management Unit (NNRC–CPMU) has been set up to strengthen the quality of
program implementation, monitoring and systems in the country. The NNRC-
CPMU is supervised and guided by Joint Secretary MWCD as Ex-officio Mission
Director. Two Executive Directors manage the day to day operations, supported
by Project Managers, Consultants and Project Associates. Akin to the CPMU at
the Government of India, the SPMU at State level functions as the State Nutrition
Resource Centre. In addition, there are staff placed at district and block level.
There are substantial numbers of vacancies in POSHAN which impact rollout and
provisioning of services. Under POSHAN Abhiyaan, 190 (37%) positions at the State,
633 (45%) positions at the district and 6469 (51%) positions at the block level are
yet to be filled up. The progress of recruitment of manpower in POSHAN Abhiyaan
is being monitored through the meetings and video conferences with the State
Secretaries. This issue was also highlighted in the recent National Conference of
State Secretaries of Women & Child Development held on 13th- 14th November,
2019. DO letters are being sent regularly by the Secretary, MWCD to the Chief
Secretaries/ Administrators of States/UTs and the issue is also flagged during his
visits to the State/UT.
2.2 Training & Capacity Building: The Abhiyaan focuses on augmenting capacity
of front-line ICDS functionaries in effective and consistent manner by using
Incremental Learning Approach (ILA). Under ILA, functionaries are being trained
on 21 thematic modules following the cascade of training of State Resource Group
(SRG), District Resource Groups (DRGs) and Block Resource Groups (BRGs).These
modules have also been designed in e-learning format and a web-based learning
portal has been developed. A total of 10.00 lakhs AWWs have been trained so far
in different ILA modules. Moreover, 9.16 lakh AWWs and Supervisors have been
enrolled and 3.64 lakh have completed e-ILA Modules.
2.3 Information and Communication Technology enabled Real Time Monitoring:
The Abhiyaan empowers Anganwadi Workers (AWWs) and Lady Supervisors
with smartphones loaded with ICDS-Common Application Software (ICDS-CAS).
The software application is available in 15 languages and is aimed at improving
service delivery and nutrition outcomes through effective monitoring and timely
intervention. ICDS-CAS replaces 8.2 kg of paper registers with 173 gms of
smartphone. It enables growth monitoring of children with auto plotting of growth
chart on the mobile application; auto-generates task list and home visit scheduler
for enabling AWWs to focus on the beneficiaries based on priority. More than 6.30
lakh Anganwadi workers in 347 districts of 28 States/ UTs are using smartphones.
They have surveyed 11.02 crore households and enrolled 5.33 crore children of
0- 6 years, 34.29 lakh pregnant women, 40.50 lakh lactating mothers and 2.02 lakh
adolescent girls. In addition, more than 78000 approx. smartphones are available
with the States for roll out and 2.73 Lakhs smartphones are under procurement. In
order to ensure accurate records of weight and height, Growth Monitoring Devices
(GMDs) are being provided at Anganwadi Centres (AWCs). Children of 6 months to
6 years are weighed and their height is measured by the Anganwadi workers every
month to monitor growth. System generated SMS alerts are sent to parents of
children recording static growth. 99
3.1 Community Mobilization & Behaviour Change Communication (BCC): Organization
of Community Based Events (CBEs): In order to strengthen processes for
community engagement, empowerment of beneficiaries and increased social
accountability of ICDS, the POSHAN Abhiyaan provides for organizing Community
Based Events (CBEs) twice in a month on a fixed day of week at each Anganwadi
Centre. The processes under this component also encompass outreach visits
by Anganwadi Worker to prioritized households to promote Infant and Young
Child Feeding (IYCF) practices. So far, 3.24 crore CBEs like Annaprasan Diwas,
Suposhan Diwas, celebrating coming of age, meeting of pregnant women have been
conducted. Anganwadi Centres are also paid `250 per CBE for 2 CBEs per month.
Till 31st December, an expenditure of `598.73 crores is incurred for Community
Based Events.
3.2 Information, Education & Communication (IEC): Development of well-researched,
designed and tested communication plan & IEC materials on Nutrition is being
undertaken to refute myths and misunderstandings prevalent in the society and to
generate demand for various services being provided. The objective is to build-up
better health seeking behaviour among the masses. IEC campaigns have been taken
up both by the Ministry and by the State governments.
3.3 Jan Andolan: The Abhiyaan is focusing on converting the agenda of improving
nutrition into a “Jan Andolan” through involvement of Panchayati Raj Institutions/
Village Organizations/SHGs etc. and ensuring wide public participation. The month
of September is celebrated across the country as Poshan Maah. The second edition
of Poshan Maah was celebrated in September, 2019, during which more than 3.66
crore activities were organized which inter-alia included home visits, CBEs, Village
Health Sanitation and Nutrition Days (VHSNDs), Poshan Melas, Poshan Rallies etc.
Poshan Maah received a massive response in the social media too. A total number
of 3.4 million impressions are generated on Twitter during the month. Governors/
Chief Ministers/Administrators of 21States/UTs have participated in Poshan Maah
activities. Awareness campaign on Doordarshan, Digital Cinemas and Community
Radio was also taken up. Overall Performance in Poshan Maah 2018, Poshan
Pakhwada and Poshan Maah 2019 is at Annexure-I.
3.4 Innovations and Flexi Funds: POSHAN Abhiyaan provides funds for the development
and implementation of innovations and pilots particularly showing the convergent
nutrition action to achieve one or more desirable nutritional results. For this, `27.85
Lakhs per district is provided to the States/UTs. A total number of 22 States/UTs
have taken up various Innovative projects like Mobile Anganwadis, Nutri Gardens,
Swachhata Kits etc. Besides this, States/UTs can use 7% of total allocation towards
Flexi activities. 29 States/UTs have taken up activities from Flexi funds which
include wall paintings at Anganwadis, providing water purifier, solar lights and
fans at Anganwadis, training of Panchayati Raj Functionaries, growing vegetables
through hydroponic technique at Anganwadis etc.
3.5 Performance Incentives: POSHAN Abhiyaan provides performance based incentives
to the field functionaries for service delivery. Anganwadi Workers are provided Rs.
500 per month for using ICDS-CAS on achieving certain parameters like opening
of Centres, Home Visits and Weighing of Children. Till 31st January 2020, an
amount of `56.54 crores was paid as incentive for this purpose. Anganwadi Helper
is paid incentive of `250 per month for opening of Anganwadi Centre. Ministry
of Women and Child Development (WCD) recognized significant contributions of 100
State Governments, District teams, Block level teams and Field Functionaries at the
POSHAN Abhiyaan Award Ceremony for 2018-19 held on 23rd August, 2019. Total
363 POSHAN Abhiyaan Awards were given away with total cash prize of ₹`22 crore.
3.6 Financials : - Funds have been released to the States regularly to implement various
activities under the Abhiyaan. In 2017-18 ₹`644.54 crores, in 2018-19₹`2,555.94
crores and in 2019-20 ₹ `1,845.13 crore (as on 30.04.2020) have been released to the
States. The expenditure had been slow initially with only ₹`29.47 crores utilized in
2017-18 and ₹ `596.92 Crore in 2018-19. The pace of expenditure has picked up now
and in 2019-20, ₹ `2057.39 Crore have been utilized till 31st March, 2020. Details
of State/UT wise funds released and utilization is given at Annexure-II. States are
regularly asked to push fund utilization through meetings and DO letters.

4 Details about Convergence:
4.1 POSHAN Abhiyaan strives to converge various Schemes/Programmes of Ministries
having impact on nutrition. These include schemes of many other Ministries
like MoH&FW, Ministry of Jal Shakti, Ministry of Consumer Affairs, Food & Public
Distribution, Ministry of Rural Development, Ministry of Panchayati Raj, Ministry of
Housing and Urban Affairs and Ministry of New and Renewable Energy.
4.2 Convergence at National level is being achieved through the National Council
on India’s Nutrition Challenges, chaired by the Vice Chairman of NITI Aayog and
Executive Committee of POSHAN Abhiyaan under Secretary, MWCD. Both of them
draw members from all stakeholders of the Abhiyaan. Similarly, the Convergence
at State and District level is ensured through Convergence Action Plans formulated
under the Chairmanship of the Chief Secretary and District Magistrate respectively.
Due to concerted efforts, 30 States/UTs have now submitted Convergence Action
Plans (CAPs) to the Ministry. The matter has now been taken up States/UTs to
prepare and submit CAPs for the year 2020-21.
4.3 The Village Health Sanitation and Nutrition Day (VHSND) provides the convergence
platform at village level, for participation of all frontline functionaries of the
Departments of Health, WCD, Drinking Water and Sanitation. So far 1.79 crore
VHSNDs have been organized since the launch of POSHAN Abhiyaan.
101
Annexure-I
Performance in Poshan Maah 2018, Poshan Pakhwada and Poshan Maah
Total Activities
Maah 20193,66,55,410
Maah 201822,58,542
Pakhwada 201982,75,845
Total Participation
Maah 2019240 + Cr
Maah 201845 + Cr
Pakhwada 201925 + Cr
Bifurcation
Maah 2019
(01-30 September
2019)
Maah 2018
(01-30 September
2018)
Pakhwada 2019
(08-22 March 2019)
Female41%40%--
Male23%18%--
Male Child 17%20%--
Female Child 19%22%--
Number of Ministries
Converged
15814
Aspirational Districts
Activities
97.7 Lakhs 4.8 Lakhs--
Aspirational Districts
Activities
49 Lakhs 3 Lakhs--
THEMES PROMOTED
Themes Name Maah 2019 Maah 2018 Pakhwada 2019
Poshan
(Overall Nutrition)
23%37%21%
Hygiene, Water,
Sanitation
10%10%9%
Anaemia10%5%7%
Breastfeeding 9%6%7%
Growth Monitoring 8%7%8%
Compl. Feeding 7%8%7%
Food Fortification &
Micronutrients
6%5%7%

Diarrhoea6%2%5%
Immunisation6%4%7%
Antenatal Checkup 6%6%7%
Adolescent Ed, Diet,
Age of Marriage
5%4%8%
ECCE4%6%7% 102
ACTIVITIES STATUS
Activity NameMaah-2019Maah-2018Pakhwada-2019 Total
Total3,66,55,41022,58,542 82,75,845 4,71,89,797
Home Visits2,17,42,19498,694 18,48,045 2,36,88,933
Others26,09,270 4,18,647 14,74,270 45,02,187
CBE-Community Based Events
(ICDS)
19,74,098 3,91,730 9,07,040 32,72,868
PoshanMela13,41,679 2,63,743 8,12,711 24,18,133
Poshan Rally8,65,163 1,66,705 4,01,613 14,33,481
School Based Activities 10,03,989 85,292 2,82,763 13,72,044
VHSND7,86,748 1,50,359 4,12,891 13,49,998
Anaemia Camp8,48,511 20,412 2,85,164 11,54,087
Poshan Workshop/Seminar 5,47,452 1,26,514 2,26,815 9,00,781
Cycle Rally5,75,219 15,805 2,51,569 8,42,593
DAY-NRLM SHG Meet5,97,348 92,737 76,825 7,66,910
Poshan Walk4,94,291 56,376 2,05,209 7,55,876
Prabhat Faree4,09,163 67,441 1,41,603 6,18,207
Panchayat Meeting3,39,842 41,063 1,81,719 5,62,624
Youth Group Meeting2,95,564 21,941 2,00,315 5,17,820
Haat Bazaar Activities 2,64,271 21,469 1,39,697 4,25,437
Safe Drinking Water in Anganwadi
Centres
3,15,652 35,678 57,904 4,09,234
Community Radio Activities 3,36,471 3,380 33,734 3,73,585
Farmer Club Meeting2,27,437 10,883 1,27,102 3,65,422
Cooperative/Federation 2,62,036 4,124 50,849 3,17,009
Local Leader Meeting1,92,790 24,065 51,280 2,68,135
Safe Drinking Water in Schools 1,85,771 39,998 22,187 2,47,956
Providing Water to the Toilets 1,23,920 65,670 20,443 2,10,033
Harvest Festival1,44,582 12,441 30,109 1,87,132
Nukkad natak/ Folk Shows 1,22,414 23,375 33,988 1,79,777
Defeat Diarrhoea Campaign (D-2) 49,535 ---- ---- 49,535 103
Convergence activities by MinistryIndividual Activities
MoW&CD2,36,87,265
MoH&FW19,84,349
MoHRD4,64,939
MoRD4,33,132
MoPR1,02,607
MoA&FW59,288
MoAYUSH37,754
MoDW&S35,552
MoYA&S22,527
MoMA16,283
MoIB11,247
MoD9,893
MSDE9,580
MoHUA8,378
MoTA4,110
Activities under Convergence97,68,506
Total Activities Occurred3,66,55,410 104
Annexure-II
Status of Fund Released and Utilization under POSHAN Abhiyaan
(as on 31.03.2020)
S.
No.
State/UTs Released
in
FY 2017
– 18 +
Unspent
balance of
ISSNIP
Released in
FY 2018-
19
Released in
FY 2019-20
Total
Released
Total
Central
fund
Utiliza-
tion as on
31.03.2020
% Cen-
tral
share
Utiliza-
tion of
funds
released
till date
1
Andhra
Pradesh
2,572.41 8,604.68 13296.5224473.61 10682.46 43.65
2Bihar 7,063.4415,001.67 25465.0047530.11 21040.65 44.27
3Chhattisgarh 1,668.12 9,629.51 0.0011297.63 5364.23 47.48
4Delhi 945.95 2,206.88 0.003152.83 1811.94 57.47
5Goa238.07 197.78 0.00 435.85 192.46 44.16
6Gujarat 3,036.6611,228.04 14863.0029127.69 14348.53 49.26
7Haryana 400.97 5,992.46 0.006393.43 3259.17 50.98
8
Himachal
Pradesh
1,557.26 4,153.15 4960.0010670.41 5633.73 52.80
9
Jammu &
Kashmir
388.59 8,343.52 0.008732.11 3865.21 44.26
10Jharkhand 2,429.59 5,110.45 0.007540.04 3214.03 42.63
11Karnataka 3,351.05 9,870.89 0.0013221.94 3945.42 29.84
12Kerala 1,273.37 6,491.91 0.007765.28 4483.53 57.74
13
Madhya
Pradesh
4,067.2015,894.17 17883.0037844.37 14209.57 37.55
14Maharashtra 2,572.3120,989.28 33061.4756623.06 32037.00 56.58
15Odisha 4,600.4610,571.65 0.0015172.11 1201.13 7.92
16Puducherry 39.24 393.70 497.00 929.94 202.70 21.80
17Punjab 819.51 6,090.33 0.006909.84 1544.89 22.36
18Rajasthan 4,216.26 9,680.99 8941.0022838.25 7319.03 32.05
Amount in lakhs 105
19Tamil Nadu 1,340.5112,210.9311509.00 25060.4414144.35 56.44
20Telangana 1,736.948,595.70 7003.00 17335.64 4601.71 26.54
21Uttar Pradesh8,440.6029,582.8716166.00 54189.4718273.15 33.72
22Uttarakhand 1,866.254,301.57 7086.00 13253.82 5250.08 39.61
23West Bengal 5,545.2719,294.11 0.00 24839.38 0.00 0.00
24
Arunachal
Pradesh
52.93 2,663.35 0.00 2716.28 257.68 9.49
25Assam 2,298.2715,492.3614171.00 31961.6314433.87 45.16
26Manipur 340.46 3,865.37 0.00 4205.83 2138.40 50.84
27Meghalaya 462.98 1,713.27 2802.80 4979.05 3883.05 77.99
28Mizoram 119.38 957.65 1498.00 2575.03 1731.32 67.23
29Nagaland
163.74 1,251.97 2298.17 3713.88 3221.33 86.74
30Sikkim
98.59 328.47 923.00 1350.06 962.82 71.32
31Tripura
277.91 3,695.72 0.00 3973.63 633.53 15.94
32Andaman &
Nicobar
100.22 416.89 307.62 824.73 313.57 38.02
33Chandigarh
158.88 306.82 526.97 992.67 406.76 40.98
34Dadra &
Nagar Haveli
108.83 129.32 681.16 919.31 307.52 33.45
35Daman & Diu
42.06 197.66 446.98 686.70 612.66 89.22
36Ladakh
- - - - - -
37Lakshadweep
60.00 138.90 126.75 325.65 211.14 64.84
TOTAL
64,454.282,55,593.99184513.44504561.7205738.62 40.78
CPMU
Expenses
2,827.003,877.00 1,857.00 8,561.008,561.00 -
Grand Total
67,281.282,59,470.98186,370.44513,122.7214,299.6241.76 106 107
@
APPENDIX II 108
1. Implementation of ICDS-CAS
1.1. National Overview 109
1.2. Program Summary
AWC Infrastructure
AWCs Reported Clean
Drinking Water
73.29%
(2,77,324 / 3,78,392)
AWCs Reported
Weighing Scale: Infants
80.85%
(3,05,923 / 3,78,392)
AWCs Reported
Medicine Kit
45.16%
(1,70,870 / 3,78,392)
AWCs Reported
Functional Toilet
54.28%
(2,05,383 / 3,78,392)
AWCs Reported
Weighing Scale: Mother
and Child
73.30%
(2,77,363 / 3,78,392)
AWCs Reported
Infantometer
69.49%
(2,62,948 / 3,78,392) 110
Demographics
Aadhaar-seeded
Beneficiaries
30.66%
(1,66,46,331 /
5,42,87,586)
Pregnant women
enrolled for Anganwadi
Services
99.29%
(26,56,284 / 26,75,333)
Children enrolled for
Anganwadi Services
98.49%
(4,74,98,539 /
4,82,27,124)
Lactating women
enrolled for Anganwadi
Services
99.74%
(41,32,763 / 41,43,591) 111
Maternal and Child Nutrition
Underweight (Weight-
for-age) 13.56%
(29,76,400 /
2,19,45,138)
Stunting
(Height-for-Age)
32.49%
(58,69,601 / 1,80,64,423)
Early Initiation of
Breastfeeding
62.66%
(2,83,681 / 4,52,730)
Children initiated appropriate
Complementary Feeding
68.44%
(11,13,735 / 16,27,217)
Wasting
(Weight-for-Height)
7.07%
(12,70,119 / 1,79,53,764)
Newborns with Low
Birth Weight
11.69%
(36,784 / 3,14,607)
Exclusive Breastfeeding
58.14%
(23,85,098 / 41,02,022)
Institutional Deliveries
89.02%
(2,81,196 / 3,15,875) 112
1.3. Anganwadi Worker using ICDS-CAS
The following graph ranks the 27 ICDS-CAS launched States / UTs in terms of districts and AWCs
launched in each State / UT having an equal weightage for both the indicators.
Table 1: Anganwadi Workers using ICDS-CAS
S.No. States / UTs Total AWCs AWCs
launched
AWCs rollout
%
Rank
1 Andaman & Nicobar Islands 720 715 99.31% 6
2 Andhra Pradesh55,607 55,586 99.96% 2
3 Assam62,153 12511 20.13% 23
4 Bihar115,009 94874 82.49% 15
5 Chandigarh450 450 100.00% 1
6 Chhattisgarh52,474 10,473 19.96% 24
7 Dadra & Nagar Haveli 303 303 100.00% 1
8 Daman & Diu107 102 95.33% 12
9 Delhi10,897 9,984 91.62% 14
10Goa1,262 1215 96.28% 11
11Gujarat53,029 53,010 99.96% 2
12Himachal Pradesh18,925 18,869 99.70% 4
13Jharkhand38,432 11,200 29.14% 20
14Kerala33,318 33110 99.38% 5
15Lakshadweep107 67 62.62% 17
16Madhya Pradesh97,135 27,811 28.63% 21
17Maharashtra110,486 109637 99.23% 7
18Meghalaya5,896 5,831 98.90% 9
19Mizoram2,244 2,244 100.00% 1
20Nagaland3,980 3,730 93.72% 13
21Puducherry855 848 99.18% 8
22Rajasthan62,010 20,991 33.85% 18
23Sikkim1,308 821 62.77% 16
24Tamil Nadu54,439 54,413 99.95% 3
25Telangana35,700 11,157 31.25% 19
26Uttar Pradesh190,145 51,847 27.27% 22
27Uttarakhand20,067 19,570 97.52% 10 113
1.4. Supervisors launched
The following table ranks the 27 ICDS-CAS launched States / UTs in terms of number of launched
lady supervisors in each State / UT.
S.No. States / UTs
Total
Supervisors
Supervisors
with
smartphone
Launched % Rank
1 Andaman & Nicobar 28 0 0.00% 18
2 Andhra Pradesh 2227 2210 99.24% 3
3 Assam2280 0 0.00% 18
4 Bihar4210 451 10.71% 16
5 Chandigarh18 18 100.00% 1
6 Chhattisgarh1866 399 21.38% 11
7 Dadra & Nagar Haveli 11 11 100.00% 1
8 Daman & Diu4 0 0.00% 18
9 Delhi432 0 0.00% 18
10Goa50 0 0.00% 18
11Gujarat2122 2011 94.77% 6
12Himachal Pradesh 735 727 98.91% 4
13Jharkhand1435 221 15.40% 13
14Kerala1327 0 0.00% 18
15Lakshadweep9 0 0.00% 18
16Madhya Pradesh 3379 481 14.23% 14
17Maharashtra3899 3706 95.05% 5
18Meghalaya185 150 81.08% 7
19Mizoram90 47 52.22% 10
20Nagaland159 106 66.67% 9
21Puducherry34 0 0.00% 18
22Rajasthan2232 446 19.98% 12
23Sikkim52 0 0.00% 18
24Tamil Nadu1782 1230 69.02% 8
25Telangana1268 147 11.59% 15
26Uttar Pradesh 6718 285 4.24% 17
27Uttarakhand598 0 0.00% 18 114
1.5. Districts covered
Number of Districts in 27 States/UTs where ICSD-CAS has been rolled-out in is given in Table 3
below:
Table 3: Number of districts using ICDS-CAS
S.No. States / UTs Total DistrictsLaunched DistrictsDistrict rollout %
1 A & N Islands33100.0%
2 Andhra Pradesh1313100.0%
3 Assam33927.3%
4 Bihar3838100.0%
5 Chandigarh11100.0%
6 Chhattisgarh27725.9%
7 Dadra & Nagar Haveli 11100.0%
8 Daman & Diu22100.0%
9 Delhi1111100.0%
10Goa22100.0%
11Gujarat3333100.0%
12Himachal Pradesh 1212100.0%
13Jharkhand24729.2%
14Kerala1414100.0%
15Lakshadweep11100.0%
16Madhya Pradesh511631.4%
17Maharashtra3636100.0%
18Meghalaya1111100.0%
19Mizoram88100.0%
20Nagaland1111100.0%
21Puducherry44100.0%
22Rajasthan33927.3%
23Sikkim44100.0%
24Tamil Nadu3232100.0%
25Telangana311032.3%
26Uttar Pradesh752533.3%
27Uttarakhand1313100.0% 115
1.6. Opening of Anganwadis
The following table ranks the 27 ICDS-CAS launched States / UTs in terms of number of Average
days an AWC was open in the state.
S.No. States / UTs Avg. no. of Days AWCs open Rank
1 Andaman & Nicobar322
2 Andhra Pradesh138
3 Assam915
4 Bihar381
5 Chandigarh125
6 Chhattisgarh718
7 Dadra & Nagar Haveli125
8 Daman & Diu223
9 Delhi1111
10 Goa223
11 Gujarat333
12 Himachal Pradesh1210
13 Jharkhand718
14 Kerala147
15 Lakshadweep125
16 Madhya Pradesh166
17 Maharashtra362
18 Meghalaya1111
19 Mizoram817
20 Nagaland1111
21 Puducherry420
22 Rajasthan915
23 Sikkim420
24 Tamil Nadu324
25 Telangana1014
26 Uttar Pradesh255
27 Uttarakhand138 116
1.7. Home Visits
The following table ranks the 27 ICDS-CAS launched States / UTs in terms of home visits
conducted by the AWWs for counselling the beneficiaries which is defined as “of the total number
of expected home visits, the percentage of home visits completed by AWWs”.
S.No. States / UTsHome VisitsRank
1 Andaman & Nicobar Islands 78.99%13
2 Andhra Pradesh91.11%2
3 Assam35.05%24
4 Bihar29.51%25
5 Chandigarh97.93%1
6 Chhattisgarh84.67%9
7 Dadra & Nagar Haveli90.77%4
8 Daman & Diu82.10%11
9 Delhi40.78%22
10 Goa11.94%27
11 Gujarat90.45%5
12 Himachal Pradesh87.14%7
13 Jharkhand55.39%20
14 Kerala21.85%26
15 Lakshadweep39.67%23
16 Madhya Pradesh89.94%6
17 Maharashtra90.78%3
18 Meghalaya58.46%19
19 Mizoram77.90%14
20 Nagaland52.36%21
21 Puducherry74.18%15
22 Rajasthan82.39%10
23 Sikkim63.13%16
24 Tamil Nadu85.27%8
25 Telangana80.16%12
26 Uttar Pradesh62.18%17
27 Uttarakhand60.88%18 117
1.8. Pre-School Education
The following table ranks the 27 ICDS-CAS launched States / UTs in terms of attendance of
children for Pre-School Education which is defined as “of the total children between 3-6 years
of age and enrolled for Anganwadi services, the percentage of children who attended pre-school
education for at least 21 days in the current month”.
S.No. States / UTsPSE>=21 daysRank
1 Andaman & Nicobar22.34%8
2 Andhra Pradesh31.09%5
3 Assam0.15%22
4 Bihar7.92%14
5 Chandigarh20.28%9
6 Chhattisgarh27.68%6
7 Dadra & Nagar Haveli44.54%3
8 Daman & Diu47.07%1
9 Delhi0.02%23
10 Goa0.00%24
11 Gujarat32.12%4
12 Himachal Pradesh15.36%12
13 Jharkhand5.40%16
14 Kerala0.00%24
15 Lakshadweep0.00%24
16 Madhya Pradesh27.46%7
17 Maharashtra46.70%2
18 Meghalaya6.73%15
19 Mizoram1.59%20
20 Nagaland2.29%18
21 Puducherry2.25%19
22 Rajasthan9.74%13
23 Sikkim0.00%24
24 Tamil Nadu16.24%11
25 Telangana17.75%10
26 Uttar Pradesh1.46%21
27 Uttarakhand2.55%17 118
1.9. Distribution of Take-Home Rations
The following table ranks the 27 ICDS-CAS launched States / UTs in terms of THR distribution
which is defined as “of the total number of pregnant women, lactating mothers (0-6 months
children) and 6-36 months children enrolled for Anganwadi services, the percentage who were
provided THR for at least 21 days in the current month”.
S.No. States / UTsTHR>=21 daysRank
1 Andaman & Nicobar59.24%13
2 Andhra Pradesh76.17%6
3 Assam12.36%22
4 Bihar21.74%19
5 Chandigarh43.79%14
6 Chhattisgarh69.64%10
7 Dadra & Nagar Haveli65.33%11
8 Daman & Diu81.99%2
9 Delhi0.19%27
10 Goa0.31%26
11 Gujarat78.05%3
12 Himachal Pradesh89.26%1
13 Jharkhand41.42%15
14 Kerala3.57%25
15 Lakshadweep10.63%23
16 Madhya Pradesh77.01%4
17 Maharashtra72.80%8
18 Meghalaya20.75%20
19 Mizoram39.15%16
20 Nagaland9.21%24
21 Puducherry72.99%7
22 Rajasthan35.67%18
23 Sikkim17.88%21
24 Tamil Nadu76.75%5
25 Telangana65.14%12
26 Uttar Pradesh37.63%17
27 Uttarakhand69.76%9 119
1.10. Weighing and Height Measurement Efficiency
The following table ranks the 27 ICDS-CAS launched States / UTs in terms of weighing efficiency
and height measurement efficiency in each State / UT having an equal weightage for both the
indicators, which is defined as “of the total children between 0-5 years of age and enrolled for
Anganwadi services, the percentage of children who were weighed in the current month”.
S.No. States / UTs Weighing
Efficiency
Height
Measurement
Efficiency
Weighted
Score
Rank
1 Andaman & Nicobar 65.54% 63.56% 64.55% 12
2 Andhra Pradesh 94.84% 92.96% 93.90% 2
3 Assam15.46% 13.34% 14.40% 22
4 Bihar15.12% 13.28% 14.20% 23
5 Chandigarh99.35% 98.36% 98.86% 1
6 Chhattisgarh74.74% 57.23% 65.98% 11
7 Dadra & Nagar Haveli 89.44% 88.54% 88.99% 5
8 Daman & Diu93.31% 90.67% 91.99% 3
9 Delhi3.20% 1.59% 2.40% 26
10 Goa1.25% 0.52% 0.88% 27
11 Gujarat91.96% 67.84% 79.90% 7
12 Himachal Pradesh 79.28% 42.30% 60.79% 13
13 Jharkhand23.75% 19.10% 21.42% 19
14 Kerala4.14% 2.31% 3.23% 25
15 Lakshadweep15.38% 15.17% 15.28% 20
16 Madhya Pradesh 92.12% 88.22% 90.17% 4
17 Maharashtra81.19% 71.64% 76.42% 8
18 Meghalaya29.03% 22.74% 25.88% 17
19 Mizoram47.28% 42.55% 44.91% 15
20 Nagaland15.42% 12.41% 13.91% 24
21 Puducherry50.94% 46.90% 48.92% 14
22 Rajasthan86.77% 82.41% 84.59% 6
23 Sikkim39.71% 9.06% 24.39% 18
24 Tamil Nadu70.62% 64.26% 67.44% 10
25 Telangana75.07% 70.98% 73.03% 9
26 Uttar Pradesh24.99% 5.52% 15.26% 21
27 Uttarakhand46.75% 23.43% 35.09% 16 120
1.11. Underweight Children
The following table ranks the 27 ICDS-CAS launched States / UTs in terms of Underweight
Children which is defined as “of the total children enrolled for Anganwadi services and weighed,
the percentage of children between 0-5 years who were moderately/severely underweight in the
current month”
S.No. States / UTs % Underweight Children (0-5 years) Rank
1 Andaman & Nicobar11.09%13
2 Andhra Pradesh10.05%11
3 Assam24.38%23
4 Bihar29.86%26
5 Chandigarh9.99%10
6 Chhattisgarh17.82%18
7 Dadra & Nagar Haveli42.94%27
8 Daman & Diu21.11%20
9 Delhi12.98%15
10Goa29.02%25
11Gujarat12.84%14
12Himachal Pradesh6.64%5
13Jharkhand14.28%16
14Kerala22.14%22
15Lakshadweep27.78%24
16Madhya Pradesh21.54%21
17Maharashtra15.11%17
18Meghalaya10.80%12
19Mizoram2.97%1
20Nagaland6.07%4
21Puducherry7.17%6
22Rajasthan8.48%7
23Sikkim3.70%2
24Tamil Nadu8.72%8
25Telangana18.16%19
26Uttar Pradesh8.86%9
27Uttarakhand4.30%3 121
1.12. Wasting (Weight-for-Height)
The following table ranks the 27 ICDS-CAS launched States / UTs in terms of Wasting (Weight-for-
Height) which is defined as “of the total children enrolled for Anganwadi services, whose weight
and height was measured, the percentage of children between 0-5 years who were moderately/
severely Wasted in the current month”
S.No.States / UTs% Children (0-5 years) with Wasting Rank
1 Andaman & Nicobar5.94%12
2 Andhra Pradesh4.52%4
3 Assam12.19%25
4 Bihar12.46%26
5 Chandigarh5.15%6
6 Chhattisgarh8.80%18
7 Dadra & Nagar Haveli14.05%27
8 Daman & Diu8.97%19
9 Delhi5.16%7
10 Goa11.27%24
11 Gujarat9.32%21
12 Himachal Pradesh5.65%9
13 Jharkhand7.43%16
14 Kerala10.78%23
15 Lakshadweep9.30%20
16 Madhya Pradesh9.55%22
17 Maharashtra5.79%10
18 Meghalaya5.81%11
19 Mizoram1.67%1
20 Nagaland3.87%3
21 Puducherry7.06%14
22 Rajasthan5.59%8
23 Sikkim4.56%5
24 Tamil Nadu7.11%15
25 Telangana8.07%17
26 Uttar Pradesh6.74%13
27 Uttarakhand3.42%2 122
1.13. Stunting (Height-for-Age)
The following table ranks the 27 ICDS-CAS launched States / UTs in terms of Stunting (Height-for-
Age) which is defined as “of the total children enrolled for Anganwadi services, whose height was
measured, the percentage of children between 0-5 years who were moderately/severely Stunted in
the current month”
S.No. States / UTs % Children (0-5 years) with Stunting Rank
1 Andaman & Nicobar24.43%7
2 Andhra Pradesh28.21%11
3 Assam45.98%24
4 Bihar50.22%25
5 Chandigarh31.47%13
6 Chhattisgarh42.74%20
7 Dadra & Nagar Haveli64.27%27
8 Daman & Diu35.87%16
9 Delhi37.74%18
10 Goa44.52%22
11 Gujarat28.42%12
12 Himachal Pradesh19.19%2
13 Jharkhand37.05%17
14 Kerala43.63%21
15 Lakshadweep58.82%26
16 Madhya Pradesh45.59%23
17 Maharashtra33.90%14
18 Meghalaya35.38%15
19 Mizoram15.31%1
20 Nagaland25.36%9
21 Puducherry20.08%3
22 Rajasthan27.04%10
23 Sikkim23.01%6
24 Tamil Nadu24.67%8
25 Telangana42.70%19
26 Uttar Pradesh22.68%5
27 Uttarakhand20.82%4 123
1.14. Newborns with Low Birth Rate
The following table ranks the 27 ICDS-CAS launched States / UTs in terms of Low Birth Rate which
is defined as “of all the children born and weighed in the current month and enrolled for Anganwadi
services, the percentage that had a birth weight less than 2500 grams”
S.No. States / UTs % Newborn with LBW Rank
1 Andaman & Nicobar23.33%26
2 Andhra Pradesh7.23%3
3 Assam17.99%22
4 Bihar14.81%18
5 Chandigarh13.13%14
6 Chhattisgarh10.83%9
7 Dadra & Nagar Haveli22.02%25
8 Daman & Diu8.48%5
9 Delhi21.05%24
10 Goa44.44%27
11 Gujarat8.28%4
12 Himachal Pradesh12.97%13
13 Jharkhand11.31%10
14 Kerala10.74%7
15 Lakshadweep0.00%1
16 Madhya Pradesh14.11%16
17 Maharashtra16.90%21
18 Meghalaya12.49%11
19 Mizoram6.22%2
20 Nagaland20.38%23
21 Puducherry15.16%19
22 Rajasthan12.86%12
23 Sikkim15.97%20
24 Tamil Nadu9.03%6
25 Telangana13.45%15
26 Uttar Pradesh10.75%8
27 Uttarakhand14.34%17 124
2. Setting up of State Program Management Unit, District and
Block Level Help Desk
Sl.
State LevelDistrict LevelBlock Level
State/UT SanctionedFilled
up
%
Vacant
SanctionedFilled
up
%
Vacant
Sancti
oned
Filled
up
%
Vacant
1A&N Islands10 10 0% 6 6 0% 10 10 0%
2Andhra Pradesh 10 9 10% 26 26 0% 514 503 2%
3Arunachal Pradesh 11 2 82% 50 1 98% 196 2 99%
4Assam19 16 16% 66 66 0% 460 460 0%
5Bihar19 19 0% 76 63 17% 1088 378 65%
6Chandigarh14 14 0% 2 0 100% 6 6 0%
7Chhattisgarh 18 12 33% 54 15 72% 220 45 80%
8Dadra & Nagar Haveli 12 12 0% 2 2 0% 4 4 0%
9Daman and Diu 9 6 33% 4 2 50% 4 3 25%
10Delhi13 1 92% 22 0 100% 190 0 100%
11Goa13 1 92% 4 0 100% 24 0 100%
12Gujarat19 19 0% 66 66 0% 672 668 1%
13Haryana13 5 62% 44 23 48% 296 71 76%
14Himachal Pradesh 13 10 23% 24 20 17% 156 107 31%
15Jammu and Kashmir 16 3 81% 40 0 100% 256 0 100%
16Jharkhand16 6 63% 48 10 79% 448 45 90%
17Karnataka13 6 54% 60 0 100% 408 0 100%
18Kerala12 8 33% 28 21 25% 304 183 40%
19Ladakh10 0 100% 4 0 100% 26 0 100%
20Lakshadweep9 5 44% 2 0 100% 18 2 89%
21Madhya Pradesh 23 23 0% 104 102 2% 906 906 0%
22Maharashtra17 15 12% 72 72 0% 1106 553 50%
23Manipur13 2 85% 32 0 100% 86 0 100%
24Meghalaya14 14 0% 22 22 0% 82 82 0%
25Mizoram10 10 0% 16 16 0% 54 54 0%
26Nagaland11 10 9% 22 22 0% 120 120 0%
27Odisha15 2 87% 60 0 100% 676 0 100%
28Puducherry9 1 89% 8 0 100% 10 0 100%
29Punjab16 1 94% 44 0 100% 310 0 100%
30Rajasthan19 19 0% 66 66 0% 608 608 0%
31Sikkim5 2 60% 8 4 50% 26 13 50%
32Tamil Nadu17 14 18% 64 54 16% 868 713 18%
33Telangana19 18 5% 62 62 0% 298 298 0%
34Tripura13 1 92% 16 0 100% 112 0 100%
35Uttar Pradesh 27 11 59% 150 0 100% 1794 0 100%
36Uttarakhand15 14 7% 26 26 0% 210 210 0%
37West BengalDATA NOT RECEIVED 125
3. Capacity Building through ILA Training and e-ILA
3.1 Coverage of Modules
S.No State/UTState Level District Level Block Level Sector Level
1 A&N Islands1-131-131-91-9
2 Andhra Pradesh1-211-211-191-19
3 Arunachal Pradesh1-61-31-31-3
4 Assam1-6 & 8 1-6 & 8 1-6 & 8 1-6 & 8
5 Bihar1-151-151-121-12
6 Chandigarh1-211-211-211-21
7 Chhattisgarh1-161-161-161-16
8 Dadra & Nagar Haveli 1-21 DRG & BRG included in SRG 1-21
9 Daman and Diu1-21 DRG & BRG included in SRG 1-21
10 Delhi1-18 (Except 8)1-14 (Except 8)1-13 (Except 8)1-13 (Except 8)
11 Goa1-101-61-61-6
12 Gujarat1-211-191-191-19
13 Haryana1-21 1-16 (Except 15) 1-111-11
14 Himachal Pradesh1-151-121-121-12
15 Jammu and Kashmir1-61-31-30
16 Jharkhand1-161-131-131-12
17 Karnataka1-6 & 8 1-6 & 8 1-41-4
18 Kerala1-121-61-51-5
19 Ladakh----
20 Lakshadweep1-61-61-61-3
21 Madhya Pradesh1-211-191-181-18
22 Maharashtra1-171-141-131-12
23 Manipur1-13 (Except 8)1-10 (Except 8)1-10 (Except 8)1-7 (Except 8)
24 Meghalaya1-191-151-151-15
25 Mizoram1-211-211-211-21
26 Nagaland1-191-191-171-17
27 Odisha1-61-3--
28 Puducherry1-161-121-121-12
29 Punjab1-6 & 8 1-4 & 8 1-4 & 8 1-4 & 8
30 Rajasthan1-161-131-131-13
31 Sikkim1-191-181-181-17
32 Tamil Nadu1-211-211-211-20
33 Telangana1-6 & 8 1-6 & 8 1-6 & 8 1-3 & 8
34 Tripura1-181-151-141-14
35 Uttar Pradesh1-21 (Except 8)1-19 (Except 8)1-16 (Except 8)1-14 (Except 8)
36 Uttarakhand1-191-181-181-16
37 West BengalNot Yet StartedNot Yet StartedNot Yet StartedNot Yet Started 126
3.2 Performance of e-ILA
S.N
o.States/UTs
Total
AWWs
En-
rolled
%
Achievem
ent of En-
rolment
Compl
eted
Traini
ng
%
Enrolled
who have
complet
ed
training
Total
LS
En-
rolled
%
Achievem
ent of En-
rolment
Com
pleted
%
En-
rolled
who
have
com-
pleted
training
1 Andaman
& Nicobar
Islands
720 718 99.72% 0 0.00% 28 25 89.29% 0 0.00%
2 Andhra
Pradesh
55607 55677 100.13% 48094 86.38% 2227 2240 100.58% 172977.19%
3 Arunachal
Pradesh
6225 3148 50.57% 6 0.19% 249 101 40.56% 0 0.00%
4 Assam 61690 40515 65.68% 0 0.00% 2280 1552 68.07% 0 0.00%
5 Bihar 114718104147 90.79% 30 0.03% 4210 2582 61.33% 43 1.67%
6 Chandigarh 450 450 100.00% 341 75.78% 18 18 100.00% 10 55.56%
7 Chhattisgarh52474 50415 96.08% 9432 18.71% 1866 1642 88.00% 31719.31%
8 Dadra & Nagar
Haveli
303 303 100.00% 221 72.94% 9 11 122.22% 2 18.18%
9 Daman & Diu 102 102 100.00% 82 80.39% 4 5 125.00% 1 20.00%
10Delhi 10897 10752 98.67% 0 0.00% 432 417 96.53% 0 0.00%
11Goa 1262 1258 99.68% 0 0.00% 50 55 110.00% 0 0.00%
12Gujarat 53029 52623 99.23% 51467 97.80% 2122 1850 87.18% 178096.22%
13Himachal
Pradesh
18925 18925 100.00% 1035 5.47% 735 670 91.16% 37 5.52%
14Jammu and
Kashmir
31938 742 2.32% 0 0.00% 1278 35 2.74% 0 0.00%
15Jharkhand 38432 38068 99.05% 917 2.41% 1435 838 58.40% 88 10.50%
16Madhya
Pradesh
97135 86232 88.78% 17128 19.86% 3379 2791 82.60% 43215.48%
17Maharashtra 110486109680 99.27% 30896 28.17% 3899 3976 101.97% 67216.90%
18Meghalaya 5896 5896 100.00% 0 0.00% 185 208 112.43% 0 0.00%
19Mizoram 2244 2244 100.00% 0 0.00% 90 71 78.89% 0 0.00%
20Nagaland 3980 3911 98.27% 0 0.00% 159 74 46.54% 0 0.00%
21Puducherry 855 855 100.00% 0 0.00% 34 30 88.24% 0 0.00%
22Rajasthan 62020 21523 34.70% 18754 87.13% 2232 763 34.18% 50365.92%
23Tamil Nadu 54439 54455 100.03% 23041 42.31% 1782 1532 85.97% 38325.00%
24Telangana 35700 34192 95.78% 0 0.00% 1268 256 20.19% 0 0.00%
25Tripura 10145 9911 97.69% 0 0.00% 406 424 104.43% 0 0.00%
26Uttar Pradesh173718160872 92.61% 8226 5.11% 6718 4016 59.78% 293 7.30%
27Uttarakhand 20067 7630 38.02% 57 0.75% 598 256 42.81% 2 0.78% 127
4. Convergence Planning
S.No State/UT Status on Submission of SCAP to CPMU ( FY 2019-20)
1 A&N IslandsSubmitted
2 Andhra PradeshSubmitted
3 Arunachal PradeshNot Submitted
4 AssamNot Submitted
5 BiharSubmitted
6 ChandigarhSubmitted
7 ChhattisgarhSubmitted
8 Dadra and Nagar HaveliSubmitted
9 Daman and DiuSubmitted
10 DelhiSubmitted
11 GoaSubmitted
12 GujaratSubmitted
13 HaryanaSubmitted
14 Himachal PradeshSubmitted
15 Jammu and KashmirNot Submitted
16 JharkhandSubmitted
17 KarnatakaNot Submitted
18 KeralaSubmitted
19 LadakhNot Submitted
20 LakshadweepSubmitted
21 Madhya PradeshSubmitted
22 MaharashtraSubmitted
23 ManipurSubmitted
24 MeghalayaSubmitted
25 MizoramSubmitted
26 NagalandSubmitted
27 OdishaNot Submitted
28 PuducherrySubmitted
29 PunjabSubmitted
30 RajasthanSubmitted
31 SikkimSubmitted
32 Tamil NaduSubmitted
33 TelanganaSubmitted
34 TripuraSubmitted
35 Uttar PradeshSubmitted
36 UttarakhandSubmitted
37 West BengalNot Submitted 128
5. Jan Andolan (Community Based Events and VHSND)
5.1. Community Based Events
Sl. StateUTs AWCs
Target
for the
quarter
(FY:
2019-20)
Q1
Achieve-
ment (FY:
2019-20)
Q1
%Achievem
ent (FY:
2019-20)
Q2
Achieveme
nt (FY:
2019-20)
Q2
%
Achieve-
ment (FY:
2019-
20)
Q3
Achieve
ment
(FY:
2019-20)
Q3
%
Achieve-
ment (FY:
1 A&N Islands 720 4320 1632 38% 3533 82% 3930 91%
2 Andhra Pradesh 55607 333642 275277 83% 331001 99% 331455 99%
3 Arunachal Pradesh6225 37350 35616 95% 33832 91% 32950 88%
4 Assam61690 370140 101722 27% 252314 68% 259505 70%
5 Bihar115009639504 528659 83% 541884 85% 493527 77%
6 Chandigarh 450 2700 2700 100% 2700 100% 2700 100%
7 Chhattisgarh 52474 307806 304424 99% 304059 99% 290482 94%
8 Dadra & Nagar
Haveli
303 1818 1786 98% 1810 100% 1814 100%
9 Daman & Diu 107 612 612 100% 612 100% 612 100%
10 Delhi10897 64524 61368 95% 76822 119% 66230 103%
11 Goa1262 7560 3581 47% 6402 85% 6156 81%
12 Gujarat 53029 318174 523169 164% 629799 198% 631263 198%
13 Haryana 25962 155772 146972 94% 46438 30% 154836 99%
14 Himachal Pradesh18925 113550 113181 100% 113181 100% 121790 107%
15 Jammu and Kash-
mir
31938 177594 157342 89% 91721 52% 104708 59%
16 Jharkhand 38432 230592 168679 73% 123001 53% 158027 69%
17 Karnataka 65911 247506 100614 41% 119762 48% 117220 47%
18 Kerala 33318 198690 0 0% 0 0% 66230 33%
19 Ladakh1139 6834 2402 35% 1216 18% 651 10%
20 Lakshadweep 107 642 0 0% 642 100% 642 100%
21 Madhya Pradesh 97135 576096 564623 98% 567359 98% 554702 96%
22 Maharashtra 110486661290 640694 97% 646393 98% 647626 98%
23 Manipur 11510 69060 65957 96% 67366 98% 68113 99%
24 Meghalaya 5896 35376 20362 58% 24363 69% 27241 77%
25 Mizoram 2244 13464 9782 73% 11906 88% 13095 97%
26 Nagaland 3980 23880 13842 58% 20246 85% 23880 100%
27 Odisha 74154 444924 0 Nil 17619 4% 17905 4%
28 Puducherry 855 5130 5130 100% 5130 100% 5130 100%
29 Punjab 27314 163734 97893 60% 110979 68% 122009 75%
30 Rajasthan 62020 372120 345610 93% 347612 93% 346254 93%
31 Sikkim1308 7848 5963 76% 6564 84% 6824 87%
32 Tamil Nadu 54439 326634 166890 51% 319953 98% 326634 100%
33 Telangana 35700 214200 193424 90% 217062 101% 204072 95%
34 Tripura 10145 60870 50824 83% 53950 89% 58212 96%
35 Uttar Pradesh 1882591127982 969599 86% 1004557 89% 955448 85%
36 Uttarakhand 20067 120042 98507 82% 125150 104% 106609 89%
37 West Bengal 119481716886 0 Not
Submitted
0 Not
Submitted
0 Not
Submitted 129
5.2. Village Health, Sanitation and Nutrition Day
Sl. States/UTs AWCs
No. of VHSND
conducted (April,
2018
to March, 2019)
No. of VHSND
conducted (April,
2019
to June, 2019)
No. of
VHSND
conducted
(July, 2019
to Sep
2019)
No. of VHSND
conducted (Oct
to Dec, 2019)
1 A&N Islands720 8640 2160 720 1438
2 Andhra Pradesh 55607 716514 165914 166433 166468
3 Arunachal Pradesh 6225 28341 17808 16916 16475
4 Assam61690 311674 77372 80680 82051
5 Bihar115009 6628860 151794 171023
6 Chandigarh450 1441350 1350 1350
7 Chhattisgarh52474 478564 137011 137794 128069
8 Dadra and Nagar Haveli 303 840213 142 142
9 Daman and Diu107 102306 306 306
10Delhi10897 63753 21508 32262 32262
11Goa1262 9343 2265 1466 1733
12Gujarat53029 380605 154791 149537 149381
13Haryana25962 148703 46306 23488 0
14Himachal Pradesh 18925 207662 56616 56616 55916
15Jammu and Kashmir 31938 77164 43495 0 45032
16Jharkhand38432 360835 101479 75405 99731
17Karnataka65911 1623050 0 35605
18Kerala33318 309090 2691 0
19Ladakh1139 Data Not Received 2512 0 1487
20Lakshadweep107 25680 214 321
21Madhya Pradesh 97135 1151386 278635 277862 258238
22Maharashtra110486 1050041 267502 267499 265046
23Manipur11510 1643 5170.56 7194 6343
24Meghalaya5896 50666 15171 12708 13776
25Mizoram2244 15086 5341 2114 2224
26Nagaland3980 9430 2258 812 2874
27Odisha74154 Data Not Received 0 25374 69124
28Puducherry855 7317855 2565 1688
29Punjab27314 104032 41584 30989 32062
30Rajasthan62020 770370 195938 194042 0
31Sikkim1308 1308 3369 3035 3225
32Tamil Nadu54439 206272 91585 163207 163228
33Telangana35700 542381 220724 192780 169937
34Tripura10145 1494 2166 2997 3158
35Uttar Pradesh 188259 2113382 370106 383145 240618
36Uttarakhand20067 103363 37837 54400 44287
37West Bengal119481 Data Not Received 0 0 0 130
6. Flexi-Funds
Sl. State/UT
Flexi Fund
Approved by SLSC
Committee
Status of Implementation/Funds Earmarked
(Rs. in lakh)
1 A&N IslandsYes Implementation Initiated (Rs.21.53)
2 Andhra PradeshYes Implementation Initiated (Rs.650.54)
3 Arunachal PradeshNo Proposal yet to be received
4 AssamYes Implementation Initiated (Rs.1348.42)
5 BiharYes Implementation Initiated (Rs.943.904)
6 ChandigarhYes Under Process
7 ChhattisgarhNo Meeting to be held shortly
8 Dadra and Nagar Haveli Yes Implementation Initiated (8.16)
9 Daman and DiuYes Implementation Initiated (Rs. 7.1)
10 DelhiYes Under Process
11 GoaNo Proposal yet to be received
12 GujaratYes Implementation Initiated
13 HaryanaYes Implementation Initiated
14 Himachal PradeshYes Implementation Initiated (Rs. 216.88)
15 Jammu and KashmirNo Proposal yet to be received
16 JharkhandYes Under Process
17 KarnatakaYes Under Process
18 KeralaYes Implementation Initiated
19 LadakhNo -
20 LakshadweepYes Implementation Initiated
21 Madhya PradeshYes Implementation Initiated
22 MaharashtraYes Implementation Initiated
23 ManipurNo Proposal yet to be received
24 MeghalayaNo Proposal yet to be received
25 MizoramYes Implementation Initiated (Rs.88.56)
26 NagalandYes Implementation Initiated (Rs.110.11)
27 OdishaNo Proposal yet to be received
28 PuducherryYes Implementation Initiated (10.95)
29 PunjabYes Under Process
30 RajasthanYes Implementation Initiated (Rs. 1288.21)
31 SikkimYes Implementation Initiated (Rs 49.98)
32 Tamil NaduYes Implementation Initiated
33 TelanganaNo Meeting to be held shortly
34 TripuraNo Meeting to be held shortly
35 Uttar PradeshYes Implementation Initiated
36 UttarakhandYes Under Process
37 West BengalNo Proposal yet to be received 131
7. Innovations
Sl. States /UT Innovation Plan
Approved
Amount
Earmarked
Activities
1 A&N Islands Yes Rs.27.85 • To provide logistics support to the AWCs.
2 Andhra Pradesh Yes Rs.362.05 • Intervention on Tribal nutrition
3 Arunachal
Pradesh
No-
4 AssamNo-
5 BiharYes Rs. 284 • SAM Management
• Improved access to good quality nutrients for
complimentary feeding for poor families.
• Nutri-garden (Potato, Munga, etc plantation)
• Iron fish supplies
• App development for real time monitoring
• Mushroom cultivation at village level
• Operationalization of community radio
• Supply of water filter
6 ChandigarhYes Rs.27.85 • Mobile Anganwadi Centres
7 Chhattisgarh No-
8 Dadra and Nagar
Haveli
Yes- • Provision of safe drinking water complete
• Providing fortified milk
• Distribution of Drumstick/Moringa Powder
• Uniform distribution to children
• Performance audit of AWCs under process
9 Daman and Diu Yes- • Peanut Laddoo for SAM & MAM 3-6 yrs
Children
• Anaemia Study of under 5-year children
10 DelhiYes Rs. 306.35 • Mobile Anganwadi Centres
11 GoaYes- • Nutri-gardens
12 GujaratYes Rs 919.05 • Engagement of adolescent counselors to
improve IYCF practices and adolescent girl
health
• Anaemia prevention in pregnant and
adolescent girls using iron utensils and
promotion of kitchen-garden.
• Development of kitchen garden in AWC
• Designing & Installation of Appropriate
Hand Washing Stations (HWS) for AWC
and Demonstration of Hand wash to create
Culture
13 HaryanaYes- • Promotion of hygiene through nail cutting
day
• Providing of Iron Utensils in AWC
14 Himachal
Pradesh
Yes Rs.29.21 • The prevention of Anaemia will be done by
AYUSH as innovation under POSHAN
Abhiyaan
15 Jammu and
Kashmir
No-
16 JharkhandNo-
17 KarnatakaNo- 132
18 KeralaYes Rs.311.92 • Fortification of rice with 12 micronutrients
done
• Supply initiated of fortified milk with Vitamin
A and Vitamin D and Flavored with natural
flavorings to enhance the nutritive value as
well as making it appealing and attractive to
children.
• An app for the deaf and dumb pregnant
women, lactating mothers, children to
sensitize them about ways improve their
nutritional and overall status.
• Dietary Diversification - Enhancement
of Amrutham Nutrimix (THR) by addition
of locally available low-cost fruits and
vegetables into different forms like cookies,
biscuits or cakes extruded in the form of
English and Malayalam (local language)
alphabhets which helps in the cognitive
development of children
19 LadakhNo - -
20 Lakshadweep No -
21 Madhya Pradesh Yes• Management of underweight children in
selected 18 districts.
• “Poshan Sopan”
• Poshan Sarokar (C-SAM)
• Sanjhi Sehat
• Running Shield
22 Maharashtra Yes• Training for sewing Godhadi and distribution
of Godhadi to mothers after delivery.
• Monitoring System for THR Distribution.
• Pilot program on Model ICDS.
• Urban Health Sanitation and Nutrition Day
(UHSND)
23 ManipurNo-
24 MeghalayaYes- • Backyard Poultry & Kitchen Gardens
25 MizoramYes Rs.222.8 • Infant & Young Child Feeding (IYCF)
• Nuti-garden
• Nutri-plate
• Operation SAM
26 Nagaland
Yes
Rs.3.04 • Smokeless chulha and Nutri-gardens
• Anaemia screening
• Intervention for malnutrition children.
27 OdishaNo-
28 PuducherryYes- • Haemoglobinometer at Anganwadi Centres to
monitor anaemia status in Pregnant, Lactat-
ing Mothers and Adolescent girls.
29 PunjabNo-
30 RajasthanYes-
31 SikkimNo-
32 Tamil NaduNo-
33 TelanganaNo-
34 TripuraNo-
35 Uttar Pradesh Yes Rs 1700
36 Uttarakhand Yes- • Swacchta Kit
37 West Bengal No- 133
8. Financial Performance under POSHAN Abhiyaan
State/UT
Central funds released
Total Central
funds released to
States/UTs
Total Central fund
utilization as on
31.12. 2019
% Central
share Utiliza-
tion of funds
released till
on 31.12.
2019
2017-18 &
2018-19* 2019-20
Andhra Pradesh 11177.09 5582.52 16759.61 8677.99 51.78
Bihar22065.11 10000.00 32065.11 18373.30 57.30
Chhattisgarh 11297.63 0.00 11297.63 3096.26 27.41
Delhi3152.83 0.00 3152.83 1254.14 39.78
Goa435.85 0.00 435.85 101.68 23.33
Gujarat14264.69 7531.00 21795.69 11222.25 51.49
Haryana6393.43 0.00 6393.43 2696.94 42.18
Jharkhand7540.04 0.00 7540.04 2065.05 27.39
Karnataka13221.94 0.00 13221.94 420.68 3.18
Kerala7765.28 0.00 7765.28 2455.31 31.62
Madhya Pradesh 19961.37 17883.00 37844.37 12404.30 32.78
Maharashtra23561.59 33061.47 56623.06 23602.32 41.68
Odisha15172.11 0.00 15172.11 0.00 0.00
Puducherry432.94 497.00 929.94 224.71 24.16
Punjab6909.84 0.00 6909.84 306.50 4.44
Rajasthan13897.25 0.00 13897.25 6315.69 45.45
Tamil Nadu13551.44 0.00 13551.44 10464.20 77.22
Telangana10332.64 7003.00 17335.64 4579.10 26.41
Uttar Pradesh 38023.47 0.00 38023.47 17132.35 45.06
West Bengal24839.38 0.00 24839.38 0.00 0.00
Arunachal Pradesh 2716.28 0.00 2716.28 0.00 0.00
Assam17790.63 14171.00 31961.63 11591.74 36.27
Himachal Pradesh 5710.41 2480.00 8190.41 4966.17 60.63
Jammu & Kashmir 8732.11 0.00 8732.11 2188.33 25.06
Manipur4205.83 0.00 4205.83 1233.24 29.32
Meghalaya2176.25 1706.80 3883.05 2144.45 55.23
Mizoram1077.03 902.00 1979.03 1461.47 73.85
Nagaland1415.71 1445.17 2860.88 1561.92 54.60
Sikkim427.06 544.00 971.06 436.75 44.98
Tripura3973.63 0.00 3973.63 810.75 20.40
Uttarakhand6167.82 3696.00 9863.82 3768.19 38.20
Total318388.68 106502.96 424891.64 155924.08 36.70
Amount in lakhs 134
UT without
Legislature
2017-18 & 2018-192019-20 Total utili-
zation as on
31.12.2019
Funds sanctioned Utiliza-
tion as on
31.03.2019
Funds
sanctioned
during
2019-20
Utilization
during
2019-20
2017-18 2018-19 Total
Andaman & Nicobar 100.22 416.89 517.11 109.27 307.62 115.22 224.49
Chandigarh 158.88 306.82 465.70 133.21 526.97 124.47 257.68
Dadra & Nagar Haveli108.83 129.32 238.15 123.98 681.16* 681.16 805.14
Daman & Diu 42.06 197.66 239.72 65.68 446.98 131.98 197.66
Ladakh- - - - - - -
Lakshadweep 60.00 138.90 198.90 72.15 126.75 126.75 198.90
TOTAL469.99 1189.59 1659.58 504.29 2089.48 1179.58 1683.87
*
Out of Rs. 681.16 lakhs sanctioned in 2019-20, Rs. 250 lakh given in POSHAN Award.
Amount in lakhs 135
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