Minister of Health and Family Welfare reports rising Anemia cases in India

New Delhi: As per WHO report on global prevalence of anaemia 2011, cases of anaemia are attributed to iron deficiency, micronutrient deficiencies (e.g. folate, riboflavin, vit-A and B-12), acute and chronic infections (e.g. malaria, cancer, tuberculosis, parasitic infections and HIV), and inherited or acquired disorders that affect haemoglobin synthesis (e.g. haemoglobinopathies), Rajya Sabha was told on Tuesday.

The National Nutrition Anaemia Prophylaxis Programme was launched in 1970 to prevent nutritional Anaemia in mothers and children. The programme was expanded and revised under the National Iron Plus Initiative (NIPI) in 2013 in an attempt to look at the Iron Deficiency Anaemia comprehensively across all life stages including adolescents and women in reproductive age group who are not pregnant or lactating.

The Anaemia Mukt Bharat- intensified Iron-plus Initiative under the Prime Minister's Overarching Scheme for Holistic Nourishment (POSHAN) Abhiyaan launched in 2018, aims to strengthen the existing mechanisms and foster newer strategies for tackling anaemia.

It focusses on 6x6x6 strategy which implies six target beneficiary groups, six interventions and six institutional mechanisms.

This strategy focuses on ensuring supply chain, demand generation and strong monitoring using the dashboard for addressing anaemia, both due to nutritional and nonnutritional causes.

The Six target groups are: 

i) Children 6-59 months,

ii) Children 5-9 years,

iii) Adolescents Girls and boys aged 10-19 years,

iv) Women in reproductive age (15- 49 years),

v) Pregnant women, and

vi) Lactating women.

The six interventions under AMB strategy are:

i) Prophylactic Iron and Folic Acid supplementation,

ii) Deworming,

iii) Intensified year-round Behaviour Change Communication campaign,

iv) Test and Treat - using digital method and point of care,

v) Provision of Iron and Folic Acid fortified foods in public health programmes, and

vi) Addressing non-nutritional causes of anaemia.

The six institutional mechanisms include:

i) Inter and intra-ministerial coordination,

ii) National Anaemia Mukt Bharat Unit,

iii) National Centre of Excellence and Advanced Research on Anaemia Control,

iv) Convergence with other ministries,

v) Strengthening supply chain and logistics and

vi) Anaemia Mukt Bharat Dashboard and Digital Portal.

Operational guidelines, training and IEC material were developed and shared with the States & UTs for effective implementation of this strategy. All the States and UTs have initiated activities regarding implementation of AMB namely prophylactic Iron folic acid supplementation, identification of anaemic cases, and referral & treatment. Currently, programme is working towards achieving reduction in anaemia prevalence particularly in women, children and adolescents.

However, it may also be noted that Covid-19 pandemic led to the closure of the schools and Aanganwadi Centres and therefore posed challenges in the implementation of this strategy like IFA supplementation in school going children and distribution of IFA tablets to out of school adolescent girls, pregnant and lactating mothers at VHSNDs.

At the same time, capacity building though training and orientation of Medical Officers and front line-workers on newer Maternal Health and Anaemia Mukt Bharat guidelines has also been disrupted because of the pandemic. To mitigate this, the Government of India has also developed and launched e-Training Modules to facilitate training of the health care providers through virtual platform amid COVID-19 pandemic.

The MoHFW has issued guidance notes to all the States and UTs regarding "Enabling Delivery of Essential Health Services during the COVID-19 Outbreak" on 14th April, 2020 and "Provision of Reproductive, Maternal, Newborn, Child, Adolescent Health plus Nutrition services during and post COVID-19 pandemic" on 24th May, 2020 for continuation of service delivery amid COVID-19 pandemic.

As per these guidance notes, the States and UTs have been advised to ensure home distribution of Iron Folic Acid supplementation to the target age groups i.e. Pre-school Children 6-59 months, Children 5-9 years, adolescents 10-19 years, Pregnant and lactating Women.

They have also been advised to undertake distribution of IFA supplements through the VHSNDs to be held in the staggered manner while ensuring all the personal protective measures and physical distancing norms by the frontline workers i.e. ASHAs/ANMs/AWWs.

Under National Health Mission, financial support is provided to the States and UTs for effective implementation of interventions under AMB strategy based on proposals submitted through their respective annual Programme Implementation Plan (PIP). Sufficient funds are made available to the States/UTs for carrying out activities pertaining to addressing anaemia. The budget allocation and expenditure of Central Government schemes towards the reduction of anaemia are placed at Annexure-1.

Under the Ministry of Consumer Affairs, Food and Public Distribution, Govt. of India, has a centrally sponsored pilot scheme on fortification of rice and its distribution under the Public Distribution System for a period of three years beginning in FY 2019-20 with total outlay of Rs 174.64 Cr, said the Minister of Health and Family Welfare, Dr Mansukh Mandaviya.

He was responding to a question on the reasons as to why there has been an increase in anaemic children between 6 to 59 months and increase in anaemic women aged 15 to 49 years despite the Anaemia-free Bharat campaign, the budget allocation and expenditure of Central Government schemes towards the reduction of Anaemia, whether Government has conducted or is considering a review of the National Nutritional Anaemia Prophylaxis Programme, if so then the details and the steps taken by Government to address this issue, given that its existing attempts have not achieved satisfactory results.

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