Community Nutrition Programs in India

1. Integrated Child Development Services (ICDS) Scheme

• Launched: 1975
• Ministry: Women and Child Development
• Target Group: Children (0-6 years), pregnant women, lactating mothers
• Services: Supplementary nutrition, immunization, health check-ups, nutrition and health education, pre-school education, referral services
• Delivery Point: Anganwadi Centers (AWCs) - over 14 lakh centers across India
• This is the backbone of all community nutrition in India.

2. POSHAN Abhiyaan (National Nutrition Mission)

• Launched: 2018
• Ministry: Women and Child Development
• Target Group: Children (0-6 years), adolescent girls, pregnant women, lactating mothers
• Key Features:
  • Uses technology via the POSHAN Tracker (ICT-based platform)
  • Focuses on reducing stunting, wasting, undernutrition, and anaemia
  • Over 69.4 lakh pregnant women and 42.5 lakh lactating women covered (as of 2024)
  • Observes Rashtriya Poshan Maah (National Nutrition Month) every September

3. PM POSHAN Scheme (Previously Mid-Day Meal Scheme)

• Launched: 1995 (renamed PM POSHAN in 2021)
• Ministry: Education
• Target Group: Children in Classes 1-8 in government and government-aided schools
• Benefit: Free nutritious cooked meals during school days
• Improves school enrollment, attendance, and reduces classroom hunger

4. Supplementary Nutrition Programme (SNP)

• Under: ICDS umbrella
• Target: Children 6 months to 6 years, pregnant and lactating women
• Provides: Take-home rations or hot cooked meals at Anganwadi Centers
• Addresses protein-energy malnutrition

5. Pradhan Mantri Matru Vandana Yojana (PMMVY)

• Launched: 2017
• Ministry: Women and Child Development
• Target: Pregnant and lactating women (first live birth)
• Benefit: Cash incentive of Rs. 5,000 in three installments for maternal nutrition and health care
• Encourages institutional delivery and exclusive breastfeeding

6. Anaemia Mukt Bharat (AMB) Programme

• Launched: 2018
• Ministry: Health and Family Welfare
• Target: 6 population groups - children (6-59 months), children (5-9 years), adolescent girls & boys (10-19 years), pregnant women, lactating women, women of reproductive age (15-49 years)
• Strategy: Prophylactic iron and folic acid (IFA) supplementation + deworming + behaviour change communication

7. Vitamin A Supplementation Programme

• Under: National Health Mission (NHM)
• Target: Children 9 months to 5 years
• Benefit: Bi-annual Vitamin A doses to prevent deficiency and childhood blindness
• Delivered through Anganwadis and health sub-centres

8. National Iodine Deficiency Disorders Control Programme (NIDDCP)

• Launched: 1962 (initially National Goitre Control Programme)
• Ministry: Health and Family Welfare
• Key Measure: Mandatory use of iodized salt; regular monitoring of urinary iodine levels
• Prevents goitre, cretinism, and intellectual disability

9. Targeted Public Distribution System (TPDS) / Pradhan Mantri Garib Kalyan Anna Yojana (PMGKAY)

• Ministry: Food and Public Distribution
• Target: Below poverty line (BPL) families; free food grains to ~81 crore beneficiaries (NFSA 2013)
• Benefit: Subsidized / free wheat and rice through Fair Price Shops (ration shops)
• The Central Pool as of July 2024 held over 608 lakh metric tonnes of food grains

10. National Programme for Prevention and Control of Cancer, Diabetes, CVD and Stroke (NPCDCS)

• Includes Nutrition Component: Dietary counseling and lifestyle modification at community level through health and wellness centers

11. SABLA (Rajiv Gandhi Scheme for Empowerment of Adolescent Girls)

• Target: Adolescent girls aged 11-18 years
• Benefit: Nutrition supplementation, iron-folic acid tablets, health and nutrition education, life skills training
• Being merged/integrated under POSHAN 2.0

12. POSHAN 2.0 (Saksham Anganwadi and POSHAN 2.0)

• Launched: 2021-22 (merged ICDS, POSHAN Abhiyaan, and SABLA into one umbrella)
• Components:
  • Supplementary Nutrition Programme
  • Poshan Abhiyaan (Mission-mode)
  • Scheme for Adolescent Girls
• Uses millet promotion, diversified diets, and digital tracking

13. National Programme for Control of Blindness (NPCB) - Nutritional Blindness Component

• Addresses Vitamin A deficiency-related blindness, especially in children

14. Village Health and Sanitation Days (VHND) / Nutrition Days

• Community-level monthly events at Anganwadis
• Weight monitoring, nutrition counseling, ORS distribution, immunization

15. State-Level Programs (Selected)

Summary Table

Nalgonda Technique - Park's Textbook of Preventive and Social Medicine, 28th Edition

Background: Endemic Fluorosis in India

Intervention Approaches (as per Park's, p. 740)

The Nalgonda Technique (as per Park's Textbook, p. 740)

"The National Environmental Engineering Research Institute, Nagpur developed a technique for removing fluoride by chemical treatment. It is called Nalgonda technique for defluoridation of water. It involves the addition of two chemicals (viz. lime and alum) in sequence followed by flocculation, sedimentation and filtration."

• Park's Textbook of Preventive and Social Medicine, 28th Edition, p. 740

Key Details of the Nalgonda Technique

1. Origin and Development

• Developed by the National Environmental Engineering Research Institute (NEERI), Nagpur
• Named after Nalgonda district, Andhra Pradesh, one of the most severely fluoride-affected districts in India
• Both domestic-level (bucket/drum) and community-level (fill-and-draw / continuous flow plant) systems have been developed

2. Chemicals Used

• The dose of lime is empirically 1/20th of the aluminium salt dose.
• The selection of aluminium sulphate vs. chloride depends on the sulphate and chloride content of the raw water, to avoid exceeding permissible limits.

3. Alum Dosage

• Dosage of alum varies from 145 to 1,600 mg/L (16 to 181 mg/L as Al) depending on the initial fluoride and alkalinity levels of raw water.
• The dose increases with increasing fluoride and alkalinity levels.
• A preliminary lab test is mandatory to determine fluoride concentration before treatment, as wrong dosage leads to inappropriate final pH.

4. Step-by-Step Process

Raw (fluoridated) water
        ↓
  [1] RAPID MIXING
  Add lime + alum + bleaching powder
  (Lime added first → precipitation of CaF₂)
  (Then alum added → coagulation)
        ↓
  [2] FLOCCULATION
  Slow stirring to allow formation of dense floc
        ↓
  [3] SEDIMENTATION / PRECIPITATION
  Floc settles carrying adsorbed fluoride
        ↓
  [4] FILTRATION
  Removal of residual suspended particles
        ↓
  [5] DISINFECTION
  Bleaching powder ensures microbiological safety
        ↓
  Treated water (fluoride ≤ 1.0 mg/L)

5. Chemical Reactions Involved

2NaF (aq) + Ca(OH)₂ (aq) → 2NaOH (aq) + CaF₂ (s) ↓

• Alum reacts with water alkalinity to produce insoluble aluminium hydroxide [Al(OH)₃] floc.
• Alum also reacts with fluoride ions directly, adsorbing fluoride onto the floc.
• Best fluoride removal occurs at pH 5.5 to 7.5.

6. Efficiency

• Can remove up to 90% of fluoride from water.
• Effective even when dissolved solids are above 1,500 mg/L and hardness above 600 mg/L.
• Target: achieve fluoride level of ≤ 1.0 mg/L (permissible limit).

7. Applicability

• Can be applied at two levels:
  • Domestic level - Bucket/drum defluoridation systems for household use
  • Community level - Fill-and-draw type or continuous flow defluoridation plants for piped water supply
• Can be adapted to drinking water equipment such as hand pumps.
• Simple enough to be understood and operated by common people without specialist training.

8. Limitations / Drawbacks

• Requires preliminary water testing (fluoride + alkalinity levels) to determine correct alum dose.
• Excessive aluminium dose raises residual aluminium in treated water - pH must be controlled carefully.
• Produces toxic sludge containing concentrated fluoride and aluminium, requiring proper disposal.
• Treatment is moderately expensive (as noted by Park's).
• If alum dose is miscalculated, treated water may have unacceptably high residual aluminium.

Summary