Anemia mukt bharat Psm paper long question

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Anemia Mukt Bharat (AMB) - PSM Long Answer

Introduction

Anemia is one of India's most pressing public health problems. According to NFHS-5, 67.1% of children and 59.1% of adolescent girls are anemic, and 3 in 4 Indian women have low dietary iron intake. Iron deficiency anemia causes impaired cognitive and motor development in children, decreased work capacity in adults, and in pregnancy leads to perinatal loss, prematurity, and low birth weight (LBW) babies.

To tackle this, the Government of India launched the Anemia Mukt Bharat (AMB) Strategy in 2018 under the Ministry of Health and Family Welfare, as part of the POSHAN Abhiyaan.

Aim / Goal

To reduce the prevalence of anemia by 3 percentage points per year among the six target beneficiary groups across the life cycle, implemented through a life-cycle approach.

The 6x6x6 Strategy (Original Framework)

AMB was built on 3 pillars - each with 6 components:

1. Six Target Beneficiary Groups

Beneficiary Group	Age
1. Children (infants and young children)	6-59 months
2. Children (school-going)	5-9 years
3. Adolescents	10-19 years
4. Pregnant Women	--
5. Lactating Mothers (0-6 months child)	--
6. Women of Reproductive Age (WRA)	15-49 years

2. Six Interventions

1. Prophylactic Iron and Folic Acid (IFA) Supplementation

Beneficiary	Dose & Schedule
Children 6-59 months	IFA syrup - 1 mg elemental Fe/kg/day
Children 5-9 years	Small IFA tablet weekly - 45 mg Fe + 400 mcg folic acid
Adolescents 10-19 years (WIFS)	Weekly IFA tablet - 60 mg Fe + 500 mcg folic acid
WRA (non-pregnant, 20-49 yrs)	Weekly IFA tablet - 60 mg Fe + 500 mcg folic acid
Pregnant women (from 2nd trimester)	Daily IFA tablet - 60 mg Fe + 500 mcg folic acid for minimum 180 days in pregnancy + 180 days post-partum

2. Periodic Deworming

National Deworming Day (NDD) - biannual deworming on 10th February and 10th August every year
Target: children and adolescents aged 1-19 years
Drug: Albendazole (400 mg single dose)
Pregnant women: dewormed in the second trimester during ANC visits

3. Intensified Year-Round Behaviour Change Communication (BCC) Campaign - "Solid Body, Smart Mind" focusing on:

(a) Compliance to IFA supplementation and deworming
(b) Appropriate Infant and Young Child Feeding (IYCF) practices - adequate and age-appropriate complementary foods for children 6 months and above
(c) Increase intake of iron-rich, protein-rich, and vitamin C-rich foods; dietary diversification; food fortification; harnessing locally available resources
(d) Promoting delayed cord clamping (by 3 minutes) after delivery in health facilities

4. Testing and Treatment of Anemia

Digital methods: Digital Invasive Haemoglobinometer in field settings, Sub Health Centres, Health and Wellness Centres
Semi-auto analyzer: PHC level and above
Point-of-care treatment with anemia management protocols
Special focus on pregnant women and school-going adolescents
Framework: T3 (Test - Treat - Talk) → evolved to T4 (Test - Treat - Talk - Track)

5. Mandatory Provision of Iron and Folic Acid Fortified Foods

In all government-funded public health programmes (ICDS, Mid-Day Meal, PDS, etc.)
Food fortification as a complementary strategy

6. Intensifying Awareness, Screening, and Treatment of Non-Nutritional Causes of Anemia in endemic pockets:

Malaria
Haemoglobinopathies (sickle cell disease, thalassemia)
Fluorosis

3. Six Institutional Mechanisms

Intra-ministerial coordination - MoHFW across divisions (maternal health, child health, adolescent health, nutrition, TB, NACO, NCD, NHSRC)
National Centre of Excellence and Advanced Research on Anemia (NCEARA)
Strengthening supply chain and logistics for IFA tablets
National Anemia Mukt Bharat Unit at central level
Convergence with other Ministries (Ministry of WCD, Ministry of Education, etc.)
Anemia Mukt Bharat Dashboard - digital real-time tracking of screening data, IFA supply, and coverage

Update: Shift to 7x7x7 Strategy (AMB Abhiyaan, 2026)

The programme has been restructured to a 7x7x7 framework under AMB Abhiyaan:

7th Beneficiary: Low Birth Weight (LBW) babies (0-6 months) - for timely anemia detection and risk mitigation
7th Intervention: "Eating Right" - promotion of locally available iron-rich food and dietary diversification as a long-term behavioral change
7th Institutional Mechanism: Strengthened Monitoring & Evaluation (M&E) framework with revised indicators for end-to-end tracking until anemia resolution

Implementation Platforms

AMB is delivered through existing platforms:

National Iron Plus Initiative (NIPI) and WIFS programme
Anganwadi centres (AWC) via ICDS - for children 6-59 months
Schools - via Mid-Day Meal Programme, Saathiya groups (RKSK)
ANM/ASHA at Village Health and Nutrition Days (VHND)
Adolescent Health Programme (RKSK) - peer-led interventions
PHC/CHC/DH for treatment

WHO Hemoglobin Cut-offs for Diagnosis of Anemia (2024 Update)

Population	WHO 2011	WHO 2024
Children 6-23 months	11.0 g/dL	10.5 g/dL (reduced by 0.5)
Children 24-59 months	11.0 g/dL	11.0 g/dL (unchanged)
Pregnant women (2nd trimester)	11.0 g/dL	10.5 g/dL (reduced by 0.5)
Men (15+ years)	13.0 g/dL	13.0 g/dL
Non-pregnant women (15+ years)	12.0 g/dL	12.0 g/dL

Severity classification: Mild / Moderate (Hb 7.0-9.9 g/dL) / Severe (<7.0 g/dL)

Previous Programs Subsumed Under AMB

National Nutritional Anaemia Control Programme (NNAP) - 1970s, for pregnant/lactating women
National Iron Plus Initiative (NIPI) - 2013, expanded to all age groups
WIFS - Weekly Iron and Folic Acid Supplementation for adolescents (10-19 years), launched as part of NIPI

Progress (Recent Data)

15.4 crore children/adolescents received IFA supplements in Q2 FY 2024-25
AMB integrates with POSHAN Abhiyaan and School Health Programme
Digital tools track real-time anemia screening and supply data

Importance for PSM Exam

Key mnemonics to remember:

6x6x6 (original) → 7x7x7 (2026 Abhiyaan)
T3 (Test, Treat, Talk) → T4 (Test, Treat, Talk, Track)
NDD dates: 10th February and 10th August
IFA dose for pregnant women: 60 mg Fe + 500 mcg Folic Acid, daily, minimum 180 days in pregnancy + 180 days post-partum
WIFS: Weekly for adolescents 10-19 years AND WRA 20-49 years
Non-nutritional causes addressed: Malaria, Haemoglobinopathies, Fluorosis

Sources: Park's Textbook of Preventive and Social Medicine, p. 756 | NHM AMB Guidelines (Official) | AMB Abhiyaan Guidelines 2026, MoHFW

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