Anaemia Mukt Bharat (AMB)

24-Mar-2023: Initiatives to tackle anaemia in Women and Children

In 2018, the Government of India launched the Anaemia Mukt Bharat (AMB) strategy to reduce prevalence of anaemia in women, children and adolescents through life cycle approach. The 6X6X6 strategy aims to reduce anaemia among six beneficiaries age groups through implementation of six interventions and six institutional mechanisms. The UT of Jammu and Kashmir is implementing Anaemia Mukt Bharat strategy as per GOI guidelines.

In the UT of Jammu and Kashmir, all Reproductive, Maternal, Newborn, Child, Adolescent Health and Nutrition (RMNCAH+N) services are provided across all the districts. Further, two aspirational districts (Kupwara district and Baramulla district) are identified under the Aspirational District programme to prioritize the reproductive health of women and children, including anaemia.

Periodic deworming
- MoHFW is implementing National Deworming Day (NDD) programme under which biannual mass deworming for children and adolescents in age group 1-19 years is carried on designated dates – 10th February and 10th August every year
- Pregnant women are provided services under the strategy through antenatal care contacts (ANC clinics/ VHND) for deworming (in the second trimester)
Intensified year-round Behaviour Change Communication (BCC) Campaign for compliance to IFA and deworming; Appropriate Infant and Young Child Feeding (IYCF); Increase intake of iron-rich, protein-rich and vitamin C-rich foods; dietary diversification
Testing and Treatment of anemia using digital methods (Digital Invasive Haemoglobinometer) in field settings, Sub Health Centres, Health and Wellness Centres; and Semi-auto analyzer in health facilities PHC and above; and point of care treatment. Anaemia Management protocols to be followed are mentioned in Operational Guidelines for Anaemia Mukt Bharat
Management of severe anaemia in pregnant women by administration of IV Iron Sucrose/ Blood transfusion
Providing incentives to ASHA for identification and follow-up of high-risk pregnancies including severe anaemia in pregnant women
Provision of IFA fortified food in government funded public health programmes
Addressing non-nutritional causes of anaemia in endemic pockets with special focus on malaria, hemoglobinopathies and fluorosis
Strengthening supply chain management of Iron and Folic Acid supplements
Convergence and coordination with other line departments and ministries for strengthening implementation
National Centre of Excellence and Advanced Research on Anaemia Control (NCEAR-A) at AIIMS, Delhi engaged in capacity building of health care providers and development of training toolkit.
Prophylactic Iron Folic Acid Supplementation to all six beneficiaries age group.

Steps taken by the Ministry of Health and Family Welfare for reduction in anaemia among women and children across the country

Age group	Dose and Regime for IFA supplementation
6 – 59 months of age	Biweekly, 1 ml Iron and Folic Acid syrup. Each ml of Iron and Folic Acid syrup containing 20 mg elemental Iron + 100 mcg of Folic Acid.
5- 10 years children	Weekly, 1 Iron and Folic Acid tablet. Each tablet containing 45 mg elemental Iron + 400 mcg Folic Acid, sugar-coated, pink colour.
School going adolescent girls and boys, 10-19 years of age and Out of school adolescent girls 10-19 years age	Weekly, 1 Iron and Folic Acid tablet. Each tablet containing 60 mg elemental iron + 500 mcg Folic Acid, sugar-coated, blue colour.
Women of reproductive age (non-pregnant, non-lactating) 20-49 years.	Weekly, 1 Iron and Folic Acid tablet. Each tablet containing 60 mg elemental Iron + 500 mcg Folic Acid, sugar-coated, red colour. All women in the reproductive age group in the pre-conception period and upto the first trimester of the pregnancy are advised to have 400 mcg of Folic Acid tablets, daily.
Pregnant women and lactating mothers (0-6 months child).	Daily, 1 Iron and Folic Acid tablet starting from the fourth month of pregnancy (that is from the second trimester), continued throughout pregnancy (minimum 180 days during pregnancy) and to be continued for 180 days, post-partum. Each tablet containing 60 mg elemental Iron + 500 mcg Folic Acid, sugar-coated, red colour.

24-Mar-2023: Initiatives to tackle anaemia in Women and Children

Periodic deworming
- MoHFW is implementing National Deworming Day (NDD) programme under which biannual mass deworming for children and adolescents in age group 1-19 years is carried on designated dates – 10th February and 10th August every year
- Pregnant women are provided services under the strategy through antenatal care contacts (ANC clinics/ VHND) for deworming (in the second trimester)
Intensified year-round Behaviour Change Communication (BCC) Campaign for compliance to IFA and deworming; Appropriate Infant and Young Child Feeding (IYCF); Increase intake of iron-rich, protein-rich and vitamin C-rich foods; dietary diversification
Testing and Treatment of anemia using digital methods (Digital Invasive Haemoglobinometer) in field settings, Sub Health Centres, Health and Wellness Centres; and Semi-auto analyzer in health facilities PHC and above; and point of care treatment. Anaemia Management protocols to be followed are mentioned in Operational Guidelines for Anaemia Mukt Bharat
Management of severe anaemia in pregnant women by administration of IV Iron Sucrose/ Blood transfusion
Providing incentives to ASHA for identification and follow-up of high-risk pregnancies including severe anaemia in pregnant women
Provision of IFA fortified food in government funded public health programmes
Addressing non-nutritional causes of anaemia in endemic pockets with special focus on malaria, hemoglobinopathies and fluorosis
Strengthening supply chain management of Iron and Folic Acid supplements
Convergence and coordination with other line departments and ministries for strengthening implementation
National Centre of Excellence and Advanced Research on Anaemia Control (NCEAR-A) at AIIMS, Delhi engaged in capacity building of health care providers and development of training toolkit.
Prophylactic Iron Folic Acid Supplementation to all six beneficiaries age group.

Steps taken by the Ministry of Health and Family Welfare for reduction in anaemia among women and children across the country

Age group	Dose and Regime for IFA supplementation
6 – 59 months of age	Biweekly, 1 ml Iron and Folic Acid syrup. Each ml of Iron and Folic Acid syrup containing 20 mg elemental Iron + 100 mcg of Folic Acid.
5- 10 years children	Weekly, 1 Iron and Folic Acid tablet. Each tablet containing 45 mg elemental Iron + 400 mcg Folic Acid, sugar-coated, pink colour.
School going adolescent girls and boys, 10-19 years of age and Out of school adolescent girls 10-19 years age	Weekly, 1 Iron and Folic Acid tablet. Each tablet containing 60 mg elemental iron + 500 mcg Folic Acid, sugar-coated, blue colour.
Women of reproductive age (non-pregnant, non-lactating) 20-49 years.	Weekly, 1 Iron and Folic Acid tablet. Each tablet containing 60 mg elemental Iron + 500 mcg Folic Acid, sugar-coated, red colour. All women in the reproductive age group in the pre-conception period and upto the first trimester of the pregnancy are advised to have 400 mcg of Folic Acid tablets, daily.
Pregnant women and lactating mothers (0-6 months child).	Daily, 1 Iron and Folic Acid tablet starting from the fourth month of pregnancy (that is from the second trimester), continued throughout pregnancy (minimum 180 days during pregnancy) and to be continued for 180 days, post-partum. Each tablet containing 60 mg elemental Iron + 500 mcg Folic Acid, sugar-coated, red colour.

2022

2-Aug-2022: Steps taken under Anaemia Mukt Bharat (AMB) strategy

The Government of India implements Anaemia Mukt Bharat (AMB) strategy under POSHAN Abhiyaan with the target for reducing anaemia in the six population groups - Children (6-59 months), Children (5-9 years), Adolescents girls and boys (10-19 years), Pregnant women, Lactating women and Women of Reproductive Age (WRA) group (15-49 years) in life cycle approach. Some of the major interventions by Ministry of Health and Family Welfare (MoHFW) to address anaemia under AMB include:

Prophylactic Iron and Folic Acid Supplementation.
Deworming.
Intensified year-round Behaviour Change Communication (BCC) Campaign and delayed cord clamping.
Testing of anaemia using digital methods and point of care treatment.
Addressing non-nutritional causes of anaemia in endemic pockets with special focus on malaria, hemoglobinopathies and fluorosis.
Convergence and coordination with line department and other ministries.
Engaging National Centre of Excellence and Advanced research on Anaemia Control for capacity building of health care providers.
Monitoring progress in States/UTs using Anaemia Mukt Bharat Dashboard.

As per the fifth round of National Family Health Survey (NFHS), conducted by MoHFW during the year 2019-21, the prevalence of anaemia among women age 15-49 is 57.0 percent as compared to 53.1 percent in NFHS-4, (2015-16). However, thirteen (13) States/UTs namely Andhra Pradesh, Andaman and Nicobar Island, Arunachal Pradesh, Chandigarh, Dadra and Nagar Haveli and Daman and Diu, Haryana, Himachal Pradesh, Lakshadweep, Meghalaya, NCT of Delhi, Tamil Nadu, Uttar Pradesh and Uttarakhand have reported decline in prevalence of anaemia among women age 15-49 in NFHS-5 as compared to NFHS-4.

4-Feb-2022: Anaemia Mukt Bharat

In 2018, the Government of India launched the Anaemia Mukt Bharat (AMB) strategy with the target to reduce anaemia in the vulnerable age groups such as women, children and adolescents in life cycle approach providing preventive and curative mechanisms through a 6X6X6 strategy including six target beneficiaries, six interventions and six institutional mechanisms for all stakeholders to implement the strategy. Under AMB strategy, the interventions for tackling the problem of anaemia in all the States and UTs include:

Prophylactic Iron and Folic Acid Supplementation in all six target age groups
Intensified year-round Behaviour Change Communication (BCC) Campaign for:(a) improving compliance to Iron Folic Acid supplementation and deworming, (b) enhancing appropriate infant and young child feeding practices, (c) encouraging increase in intake of iron-rich food through diet diversity/quantity/frequency and/or fortified foods with focus on harnessing locally available resources, and (d) ensuring delayed cord clamping after delivery (by 3 minutes) in health facilities
Testing and treatment of anaemia, using digital methods and point of care treatment, with special focus on pregnant women and school-going adolescents
Addressing non-nutritional causes of anaemia in endemic pockets with special focus on malaria, hemoglobinopathies and fluorosis
Management of severe anaemia in pregnant women undertaken by administration of IV Iron Sucrose/Blood transfusion
Providing incentives to the ANM for identification and follow-up of pregnant women with severe anaemia in high priority districts (HPDs)
Training and orientation of Medical Officers and front line-workers on newer Maternal Health and Anaemia Mukt Bharat guidelines
Field level awareness by ASHAs through community mobilization activities and IEC and BCC activities

The prevalence of anaemia among six groups as per the National Family Health Survey 5 (2019-21), is 25.0 percent in men (15-49 years) and 57.0 percent in women (15-49 years). 31.1 percent in adolescent boys (15-19 yrs.), 59.1 percent in adolescent girls,52.2 percent in pregnant women (15-49 years) and 67.1percent in children (6-59 months).

The measures taken by the Government to make AMB programme more effective are:

working with other line departments and ministries for strengthening implementation
engaging National Centre of Excellence and Advanced Research on Anaemia Control (NCEAR-A) at AIIMS, Delhi in capacity building of health care providers
strengthening supply chain and logistics
development of AMB Training Toolkit for capacity building of health care providers in anaemia management and recent launch of Anaemia Mukt Bharat e-Training Modules to facilitate training of the health care providers through virtual platform amid COVID 19 pandemic which has posed a challenge in capacity building through physical trainings.

Health is a State subject and the primary responsibility for strengthening health care services including implementation of national programs lies with the respective State/UT government. However, Government is taking steps to improve the condition of anaemia among all identified groups in all States/UTs. Ministry of Health and Family Welfare provides financial and technical support to States/UTs under NHM as proposed during annual Programme Implementation Plan. Covid-19 pandemic has also hampered AMB programme implementation contributing to anaemia prevalence among all the age groups.

2021

9-Feb-2021: Activities Undertaken for Anaemia Mukt Bharat

Anaemia Mukt Bharat (AMB) strategy was launched in 2018 with the objective of reducing anaemia prevalence among children, adolescents and women in reproductive age group. 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, referral & treatment and others. Currently, programme is in its initial stages and working towards achieving reduction in anaemia prevalence particularly in women, children and adolescents.

As per recently released National Family Health Survey-V data in respect of 22 States and UTs, the State/UT-wise prevalence of anaemia reported amongst the identified population groups namely - children 6-59 months, pregnant women, women 15-49 years, adolescent girls 15-19 years and adolescent boys 15-19 years.