Community nutrition: ICDS, SNP, Poshan Abhiyaan and UN agencies

What to remember

• The Integrated Child Development Services (ICDS) started on 2 October 1975 and gives six services through the Anganwadi Centre. It is run by the Ministry of Women and Child Development and serves children under six years, pregnant women, nursing mothers and adolescent girls.
• Supplementary Nutrition Programme (SNP) is the food part of ICDS. It gives hot cooked meals, snacks and take-home rations. Poshan Abhiyaan (launched in 2018) and Mission Poshan 2.0 bring nutrition schemes together with technology and a people's movement (Jan Andolan).
• UN bodies working on nutrition are UNICEF (children), WHO (health), FAO (food and agriculture) and WFP (food aid). Their headquarters and focus are common exam questions.

What is community nutrition

Community nutrition deals with the food and nutrition problems of groups of people rather than of one patient. It looks at the causes of malnutrition in the community (poverty, poor food access, infection, low education, poor water and sanitation, poor feeding habits) and plans programmes to improve the nutritional status of the whole group, especially vulnerable groups: infants, young children, adolescent girls, pregnant and lactating women, and the elderly. The main national nutrition problems are protein energy malnutrition, anaemia, vitamin A deficiency, iodine deficiency disorders and, increasingly, overweight and diet-related diseases. This is called the "double burden" of malnutrition.

Approaches to control: food supplementation, fortification of food (for example iodised salt, fortified rice, oil and milk), supplements (IFA, vitamin A), nutrition education, growth monitoring, immunisation, health care, safe water and sanitation, and agricultural measures such as kitchen gardens.

ICDS: structure and services

Launch and aims: ICDS was started on 2 October 1975 as a centrally sponsored scheme, and it is among the world's largest early childhood programmes. Its aims are:

• To improve the nutrition and health status of children under six years
• To lay the base for proper psychological, physical and social development
• To reduce the incidence of mortality, morbidity, malnutrition and school dropout
• To coordinate policy and implementation among departments for child development
• To strengthen the mother's capacity for the child's health and nutrition needs through education

Six services:

Immunisation, health check-up and referral are delivered together with the health department (ANM, ASHA, primary health centre). Pre-school education, supplementary nutrition and nutrition and health education are delivered by the Anganwadi worker, and the other three services (immunisation, health check-up, referral) with the health system. Supplementary nutrition and pre-school education are the key to fighting stunting and improving school readiness.

Anganwadi: "Anganwadi" means a courtyard shelter. The Anganwadi Centre (AWC) is the village-level point of delivery. A main Anganwadi Centre is usually set up for a population norm that is different for rural, tribal and urban areas, and a smaller mini-Anganwadi is set up for scattered habitations. Always check the latest norms before quoting a figure.

Functionaries:

• Anganwadi Worker (AWW): a local woman, honorary worker from the community. She runs the centre, gives food, does pre-school education, weighs children, keeps records, home visits and nutrition education.
• Anganwadi Helper (AWH): helps with cooking, cleaning and bringing children to the centre.
• Supervisor (Mukhya Sevika): the field-level officer who supervises a group of Anganwadi Centres, guides workers, checks records, trains and reports. She is the person this exam serves.
• Child Development Project Officer (CDPO): heads the project at block level.
• District Programme Officer at the district level.
• Support: ANM, ASHA, medical officer of the primary health centre, panchayat and women's groups.

Records and tools: registers for beneficiaries, growth charts, immunisation records, village health and nutrition day plans, and the Poshan Tracker (a digital system) now used for daily data entry and monitoring.

Supplementary Nutrition Programme (SNP)

SNP aims to bridge the gap between recommended and actual dietary intake of children and women. It is given for about 300 days in a year. The usual forms:

• Hot cooked meal and morning snack at the centre for children aged three to six years.
• Take-home ration (THR) for children six months to three years, and for pregnant and lactating women. THR can be pre-mixed energy dense food made by self-help groups or approved producers.
• Special nutrition for severely underweight children, as per norms.

Norms for energy and protein per beneficiary are set by the government and revised from time to time; learn the principle (a given share of daily need, more for malnourished children), not an unverified figure. The National Food Security Act, 2013 makes supplementary nutrition a legal entitlement for children, pregnant and lactating women.

Poshan Abhiyaan and Mission Poshan 2.0

Poshan Abhiyaan (National Nutrition Mission): launched on 8 March 2018 (International Women's Day) at Jhunjhunu, Rajasthan. POSHAN stands for Prime Minister's Overarching Scheme for Holistic Nutrition. Its aim is to improve nutrition among children, adolescent girls, pregnant women and nursing mothers by reducing stunting, undernutrition, anaemia and low birth weight. Key features: convergence of schemes, use of technology (Poshan Tracker, devices for growth monitoring), training and capacity building, incentives for workers, community mobilisation (Jan Andolan) and social audit. Poshan Maah (September) is used to run awareness drives.

Mission Poshan 2.0 (Saksham Anganwadi and Poshan 2.0): announced in 2021 to integrate Anganwadi Services, Poshan Abhiyaan, the Scheme for Adolescent Girls and the earlier supplementary nutrition efforts into one umbrella. It focuses on outcomes, nutrition through traditional AYUSH practices, millets, fortified rice, and better Anganwadi infrastructure ("Saksham Anganwadi"). Also stresses diet diversity, local foods and nutrition awareness.

Other nutrition programmes (core list)

In Andhra Pradesh, state nutrition efforts run through Anganwadi centres, with special take-home foods for young children and women. Check the latest names of state schemes in official announcements.

UN and international agencies

Other bodies and terms: CARE and other NGOs assist with feeding programmes. ICMR-NIN (Hyderabad) gives dietary guidelines and RDA. The Food Safety and Standards Authority of India (FSSAI) regulates food safety and fortification standards. World Food Day is on 16 October, linked to FAO's founding. World Breastfeeding Week is in the first week of August. National Nutrition Week is observed in the first week of September.

Nutrition education and the supervisor's role

Nutrition education changes food habits by information, demonstration and practice. Methods: individual (home visit, counselling), group (demonstration, cooking sessions, role play, talks), and mass (posters, radio, television, street plays). Effective education is simple, uses local foods, gives a clear message, and checks that people use it. The supervisor trains workers, checks growth monitoring, verifies food quality, ensures records and community participation, and links the centre with health services.

Exam traps

• ICDS began on 2 October 1975, not in 1985 or 2018.
• ICDS has six services; pre-school education is for ages three to six, not under three.
• Poshan Abhiyaan began on 8 March 2018; Poshan 2.0 was announced in 2021.
• UNICEF is for children; FAO is for food and agriculture; WHO is for health.
• FAO headquarters is in Rome, not Geneva; WHO is in Geneva.
• Take-home ration is for children six months to three years and for women, while hot cooked meals are for children three to six years.
• The Anganwadi worker is a community-based honorary worker; the supervisor is a field officer.
• Anaemia Mukt Bharat is about anaemia; the National Iodine Deficiency Disorders Control Programme is about iodised salt.

One-liners

• 1. ICDS began on 2 October 1975.
• 2. ICDS gives six services.
• 3. The Anganwadi Centre is the village-level service point of ICDS.
• 4. SNP means Supplementary Nutrition Programme.
• 5. Poshan Abhiyaan was launched on 8 March 2018.
• 6. POSHAN stands for Prime Minister's Overarching Scheme for Holistic Nutrition.
• 7. Poshan Maah is observed in September.
• 8. The National Food Security Act, 2013 makes nutrition support a legal right.
• 9. FAO has its headquarters in Rome.
• 10. WHO has its headquarters in Geneva.
• 11. UNICEF works for children's survival and development.
• 12. World Food Day is on 16 October.

Practice questions

1. ICDS was launched on

   1. 2 October 1975
   2. 8 March 2018
   3. 15 August 1947
   4. 2 October 1985
   Answer

   A. 2 October 1975

   ICDS began on 2 October 1975.

2. The number of services provided under ICDS is

   1. four
   2. nine
   3. three
   4. six
   Answer

   D. six

   Supplementary nutrition, immunisation, health check-up, referral, pre-school education, and nutrition and health education.

3. ICDS is run by the Ministry of

   1. Agriculture
   2. Education
   3. Women and Child Development
   4. Health and Family Welfare
   Answer

   C. Women and Child Development

   The Ministry of Women and Child Development administers ICDS.

4. The word 'Anganwadi' means

   1. health camp
   2. courtyard shelter
   3. market place
   4. school for adults
   Answer

   B. courtyard shelter

   Anganwadi means courtyard shelter.

5. The village-level worker of ICDS is called the

   1. Sarpanch
   2. Anganwadi Worker
   3. District Programme Officer
   4. Child Development Project Officer
   Answer

   B. Anganwadi Worker

   The Anganwadi Worker runs the centre.

6. The officer who heads an ICDS project at block level is the

   1. Child Development Project Officer
   2. Medical Officer
   3. Anganwadi Helper
   4. Mandal Parishad President
   Answer

   A. Child Development Project Officer

   CDPO heads the project at block level.

7. Pre-school education in ICDS is meant for children aged

   1. 0 to 6 months
   2. 7 to 10 years
   3. 3 to 6 years
   4. 6 to 12 months
   Answer

   C. 3 to 6 years

   It is non-formal pre-school education for three to six years.

8. Poshan Abhiyaan was launched in

   1. 2005
   2. 2013
   3. 1975
   4. 2018
   Answer

   D. 2018

   It was launched on 8 March 2018.

9. POSHAN in Poshan Abhiyaan stands for

   1. Poor Households Support and Nutrition
   2. Public Overall Scheme for Health and Nutrition
   3. Prime Minister's Open Scheme for Hunger and Nutrition
   4. Prime Minister's Overarching Scheme for Holistic Nutrition
   Answer

   D. Prime Minister's Overarching Scheme for Holistic Nutrition

   POSHAN is an acronym for the Prime Minister's Overarching Scheme for Holistic Nutrition.

10. The World Food Programme and FAO have their headquarters in

    1. Paris
    2. Rome
    3. New York
    4. Geneva
    Answer

    B. Rome

    Both FAO and WFP are headquartered in Rome.

11. The World Health Organization has its headquarters in

    1. New York
    2. Washington D.C.
    3. Geneva
    4. Rome
    Answer

    C. Geneva

    WHO is headquartered in Geneva.

12. The UN agency mainly working for children's survival and nutrition is

    1. UNICEF
    2. FAO
    3. IFAD
    4. WTO
    Answer

    A. UNICEF

    UNICEF works for children's survival, health, nutrition and education.

13. The UN agency mainly concerned with food, agriculture and food security is

    1. WHO
    2. UNESCO
    3. UNICEF
    4. FAO
    Answer

    D. FAO

    FAO is the Food and Agriculture Organization.

14. World Food Day is observed on

    1. 16 November
    2. 5 June
    3. 16 October
    4. 1 December
    Answer

    C. 16 October

    It marks the founding of FAO.

15. Which service of ICDS is delivered mainly with the health system?

    1. take-home ration
    2. immunisation and health check-up
    3. birthday celebrations
    4. pre-school education
    Answer

    B. immunisation and health check-up

    Immunisation, health check-up and referral are delivered with health staff.

16. Take-home ration under SNP is mainly given to

    1. children aged six months to three years and women
    2. school teachers
    3. men above 60
    4. college students
    Answer

    A. children aged six months to three years and women

    THR serves young children and pregnant and lactating women.

17. Hot cooked meals at the Anganwadi are given mainly to children aged

    1. six to twelve months
    2. three to six years
    3. below six months
    4. seven to ten years
    Answer

    B. three to six years

    Older pre-school children attend the centre and receive hot meals.

18. The legal right to supplementary nutrition for children and women is provided by the

    1. Consumer Protection Act
    2. Right to Information Act, 2005
    3. National Food Security Act, 2013
    4. Factories Act, 1948
    Answer

    C. National Food Security Act, 2013

    The NFSA 2013 makes the entitlement legal.

19. Mid-day meal in schools is now run as

    1. PM POSHAN
    2. ICDS
    3. Anaemia Mukt Bharat
    4. MAA
    Answer

    A. PM POSHAN

    The mid-day meal scheme was renamed PM POSHAN.

20. Which programme focuses on reducing anaemia in all life stages with IFA, testing and treatment?

    1. Mission Indradhanush
    2. Poshan Maah
    3. MAA
    4. Anaemia Mukt Bharat
    Answer

    D. Anaemia Mukt Bharat

    Anaemia Mukt Bharat is the anaemia control strategy.

21. Which programme ensures universal use of iodised salt?

    1. National Iodine Deficiency Disorders Control Programme
    2. Mission Indradhanush
    3. National Vitamin A Prophylaxis Programme
    4. Janani Suraksha Yojana
    Answer

    A. National Iodine Deficiency Disorders Control Programme

    The NIDDCP promotes iodised salt.

22. MAA (Mother's Absolute Affection) promotes

    1. immunisation
    2. family planning only
    3. school meals
    4. breastfeeding
    Answer

    D. breastfeeding

    MAA is a breastfeeding promotion programme.

23. Which of the following is a 'double burden' of malnutrition?

    1. too little rain and too much rain
    2. two meals a day
    3. undernutrition and overnutrition together
    4. only vitamin deficiency
    Answer

    C. undernutrition and overnutrition together

    It means undernutrition coexists with overweight and diet-related disease.

24. A village has many underweight children. The supervisor's best first action is to

    1. close the centre
    2. check growth monitoring, feeding and referral at the centre
    3. stop the take-home ration
    4. ignore the records
    Answer

    B. check growth monitoring, feeding and referral at the centre

    Growth monitoring, counselling and referral are core functions.

25. An Anganwadi worker finds a severely malnourished child. The right action is

    1. refer the child for medical care and give supplementary food
    2. wait for six months
    3. give only tea and biscuits
    4. remove the child's name from the register
    Answer

    A. refer the child for medical care and give supplementary food

    Severe malnutrition needs prompt referral and nutrition support.

26. Which method of nutrition education is a group activity?

    1. personal letter
    2. radio only
    3. individual home visit
    4. cooking demonstration
    Answer

    D. cooking demonstration

    A demonstration to a group is a group method; home visits are individual.

27. The Poshan Tracker is mainly a

    1. seed bank
    2. digital platform for Anganwadi monitoring
    3. soil test kit
    4. school timetable
    Answer

    B. digital platform for Anganwadi monitoring

    It is a digital tool for data entry and monitoring of Anganwadi services.

28. Food fortification means

    1. removing fibre from food
    2. adding nutrients to commonly eaten foods
    3. canning food
    4. irradiating food only
    Answer

    B. adding nutrients to commonly eaten foods

    For example iodised salt and fortified rice.

29. The agency that regulates food safety and fortification standards in India is

    1. NABARD
    2. SEBI
    3. FSSAI
    4. ICMR
    Answer

    C. FSSAI

    FSSAI is the Food Safety and Standards Authority of India.

30. Mission Poshan 2.0 combines

    1. PM POSHAN, PDS and MGNREGA
    2. JSY, MAA and Mission Indradhanush
    3. NIDDCP, ICDS training and WIFS only
    4. Anganwadi Services, Poshan Abhiyaan and the adolescent girls scheme
    Answer

    D. Anganwadi Services, Poshan Abhiyaan and the adolescent girls scheme

    It integrates Anganwadi nutrition efforts into one umbrella mission.

31. Consider: 1. ICDS began in 1975. 2. ICDS is meant only for school-age children. Which is/are correct?

    1. 1 only
    2. 2 only
    3. Both 1 and 2
    4. Neither 1 nor 2
    Answer

    A. 1 only

    ICDS serves children below six, pregnant and lactating women and adolescent girls.

32. Consider: 1. UNICEF is concerned with children. 2. FAO is concerned with food and agriculture. Which is/are correct?

    1. 1 only
    2. 2 only
    3. Both 1 and 2
    4. Neither 1 nor 2
    Answer

    C. Both 1 and 2

    Both statements are correct.

33. Consider: 1. WHO's headquarters is in Rome. 2. WHO's headquarters is in Geneva. Which is/are correct?

    1. 1 only
    2. 2 only
    3. Both 1 and 2
    4. Neither 1 nor 2
    Answer

    B. 2 only

    Rome hosts FAO and WFP.

34. Consider: 1. The Anganwadi Worker supervises the Child Development Project Officer. 2. The Supervisor guides a group of Anganwadi Workers. Which is/are correct?

    1. 1 only
    2. 2 only
    3. Both 1 and 2
    4. Neither 1 nor 2
    Answer

    B. 2 only

    The CDPO is senior to the Supervisor, who is senior to the worker.

35. Consider: 1. Poshan Abhiyaan aims to reduce stunting and anaemia. 2. Poshan Abhiyaan encourages community mobilisation. Which is/are correct?

    1. 1 only
    2. 2 only
    3. Both 1 and 2
    4. Neither 1 nor 2
    Answer

    C. Both 1 and 2

    Both statements are correct.

36. Consider: 1. Pre-school education is not one of the six ICDS services. 2. Immunisation is one of the six ICDS services. Which is/are correct?

    1. 1 only
    2. 2 only
    3. Both 1 and 2
    4. Neither 1 nor 2
    Answer

    B. 2 only

    Pre-school education is one of the six services.

37. Consider: 1. The take-home ration can be pre-mixed and energy dense. 2. SNP has no link with the National Food Security Act. Which is/are correct?

    1. 1 only
    2. 2 only
    3. Both 1 and 2
    4. Neither 1 nor 2
    Answer

    A. 1 only

    NFSA 2013 gives the legal basis for supplementary nutrition.

38. Match the agency (I) with its headquarters (II). I: a. FAO b. WHO c. UNICEF d. World Bank. II: 1. Geneva 2. Rome 3. New York 4. Washington D.C.

    1. a-1, b-2, c-3, d-4
    2. a-2, b-3, c-1, d-4
    3. a-3, b-1, c-2, d-4
    4. a-2, b-1, c-3, d-4
    Answer

    D. a-2, b-1, c-3, d-4

    FAO-Rome; WHO-Geneva; UNICEF-New York; World Bank-Washington D.C.

39. Match the programme (I) with its focus (II). I: a. NIDDCP b. MAA c. Anaemia Mukt Bharat d. PM POSHAN. II: 1. School meals 2. Iodised salt 3. IFA and anaemia control 4. Breastfeeding.

    1. a-3, b-4, c-2, d-1
    2. a-4, b-2, c-3, d-1
    3. a-2, b-4, c-3, d-1
    4. a-2, b-3, c-4, d-1
    Answer

    C. a-2, b-4, c-3, d-1

    NIDDCP-iodised salt; MAA-breastfeeding; Anaemia Mukt Bharat-IFA; PM POSHAN-school meals.

40. Match the functionary (I) with the level (II). I: a. Anganwadi Worker b. Supervisor c. CDPO d. District Programme Officer. II: 1. District 2. Block project 3. Village centre 4. Group of centres.

    1. a-3, b-4, c-2, d-1
    2. a-3, b-2, c-4, d-1
    3. a-3, b-4, c-1, d-2
    4. a-4, b-3, c-2, d-1
    Answer

    A. a-3, b-4, c-2, d-1

    Worker-village; Supervisor-group of centres; CDPO-block; DPO-district.

41. Which one of these is NOT an ICDS service?

    1. nutrition and health education
    2. referral services
    3. supplementary nutrition
    4. cash pension for the elderly
    Answer

    D. cash pension for the elderly

    Old-age pension is not an ICDS service.

42. Who is the field officer supervising a group of Anganwadi Centres?

    1. Village Revenue Officer
    2. ASHA worker
    3. Anganwadi Helper
    4. Supervisor (Mukhya Sevika)
    Answer

    D. Supervisor (Mukhya Sevika)

    The Supervisor guides and monitors a group of centres.

43. Which cash scheme gives maternity benefit to pregnant and lactating women?

    1. Pradhan Mantri Matru Vandana Yojana
    2. National Vitamin A Programme
    3. PM POSHAN
    4. Mission Indradhanush
    Answer

    A. Pradhan Mantri Matru Vandana Yojana

    PMMVY gives a cash maternity benefit as per scheme norms.

44. Oral vitamin A is given under the national programme to children from

    1. birth to one month
    2. six to ten years
    3. teenage only
    4. nine months to five years
    Answer

    D. nine months to five years

    The vitamin A prophylaxis programme covers children up to five years.

45. Poshan Maah, the month of nutrition awareness, is observed in

    1. January
    2. April
    3. September
    4. December
    Answer

    C. September

    Poshan Maah is observed in September.