At birth itself, almost 1/3 of our children have low birth rate and it peaks within 0 to 6 years of age group. What has been worrying is the very marginal decline, in the rate of malnutrition during the period between NFHS-II and NFHS-III. Malnutrition also impacts the cognitive development and school performance of children. One study estimates that every year of schooling increases adult yearly income by 9%. The loss of adult income for being stunted but not in poverty is 22.2%, the loss from living in poverty but not being stunted is 5.9% and from being stunted and in poverty 19.8%.

National Nutrition Policy 1993 identified key areas of action in various areas like food production, food supplies, education, information, rural development, women and child development, people with special needs and monitoring and surveillance. The core strategy envisaged under NNP is to tackle the problem of nutrition through direct nutrition interventions for vulnerable groups as well as through various development policy instruments which will improve access and create conditions for improved nutrition.

The National Plan of Action on Nutrition 1995 laid down the frame work for systematic collaboration among national government agencies, State Governments, NGOs, private sector and the international community. It has been recognized that a number of programmes have been initiated to tackle malnutrition, however, gaps remain in the ability to deliver to the target groups at the grass root level. There is a need to deliver the benefits of various schemes to the household and community level.

The 11th Five Year Plan positions the development of children at its centre and recognizes nutrition as critical for ensuring child survival and development. It accords high priority to addressing maternal and child security.

The objective of the Strategy to Address India's Nutrition Challenges, as defined in the Eleventh Plan Monitorable Targets, are as follows:

Ø Reduce malnutrition among children (underweight prevalence) in the age group 0-3 years to half its present level, by the end of the Eleventh Plan.

Ø Reduce anemia among women and girls by 50% by the end of the Eleventh Plan.

After deliberations with the Ministry of Health & Family Welfare, State WCD Secretaries, major recommendations are as follows:

i) For better policy co-ordination, there should be a support unit in Planning Commission to support PM's Council.

ii) Nutrition to be made central to develop agenda and nutrition component to be prioritized in all flagship programmes.

iii) Special emphasis on nutrition status of under 3s.

iv) Improvement in human resources development at village level, Central Nutrition Councillors / Addditional AWWs at village level. Initially, high burden districts can be taken up. Role of ASHA, AWW, ANM to be harmonized. v) Attach doctors on call under ICDS in the AWCs.

vi) Launch joint training initiative under NRHM under ICDS to strengthen continuum of care to pregnant mothers under 2.

vii) Strengthen Nutritional Rehabilitation Centres under NRHM by linking them to child health units.

viii) ICDS re-structuring to provide greater flexibility to States and districts with regard to implementation.

ix) Co-location of schools of AWCs for sharing of resources and better monitoring.

x) Attention needs to be paid for creation of infrastructure under ICPS in form of Anganwadi buildings equipped with requisite facilities. At present 20% centers are in Kutcha buildings and out of remaining 80% Pucca buildings, 50% are in rented buildings. (convergence envisaged NREG, NRHM, TSC, Thirteenth FC, ARWSP, BADP, TSP, BRGF, Multisectoral Development Plan.

xi) Efficient management of Supplementary Nutrition Programme.

xii) Institutional linkages n NREGs and provision for human resources at the village level such as Nutrition Educator, ECCE Educator and H&N record keeper as skilled workers under NREGS.

xiii) Early approval for launching of RGSEAG and IGMSY to address the intergenerational cycle of undernutrition.

xiv) More efficient communication and counseling campaigns.

xv) Better monitoring and evaluation by lining ICDS, MIS and Health MIS.

xvi) Strengthen Nutrition Surveillance by proper mapping of high risk and vulnerable districts and by setting up working group in surveillance for health and nutrition at Central level in NRHM and ICDS comprising experts from various fields.