Integrated Child Development Services 2019: Pediatric malnutrition has always been a matter of national concern. The various vertical health programmes initiated by the Government of India (GOI) from time to time did not reach out to the target community adequately.
In 1974, India adopted a well-defined national policy for children. In pursuance of this policy, it was decided to start a holistic metacentric programme with a compact package of services. The decision led to the formulation of the Integrated Child Development Services (ICDS) scheme – one of the most prestigious and premier national human resource development programmes of the GOI.
The scheme was launched on 2 October 1975 in 33 (4 rural, 18 urban, 11 tribals) blocks. Over the last 25 years, it was expanded progressively and at present it has 5614 (central 5103, state 511) projects covering over 5300 community development blocks and 300 urban slums; over 60 million children below the age of 6 years and over 10 million women between 16 and 44 years of age and 2 million lactating mothers .
Integrated Child Development Services 2019
The total population under ICDS coverage is 70 million, which is approximately 7 percent of the total population of one billion. The main thrust of the scheme is on the villages where over 75 percent of the population lives. Urban slums are also a priority area of the programme.
The main objectives of the scheme are :
- Improvement in the health and nutritional status of children 0–6 years and pregnant and lactating mothers.
- Reduction in the incidence of their mortality and school drop out
- Provision of a firm foundation for proper psychological, physical and social development of the child.
- Enhancement of the maternal education and capacity to look after her own health and nutrition and that of her family
- Effective coordination of the policy and implementation among various departments and programmes aimed to promote child development.
The beneficiaries are:
- Children 0–6 years of age
- Pregnant and lactating mothers
- Women 15–44 year of age
- Since 1991 adolescent girls up to the age of 18 years for non-formal education and training on health and nutrition.
The programme provides a package of services facilities  like:
i) Complementary nutrition
ii) Vitamin A
iii) Iron and folic acid tablets
v) Health check-up
vi) Treatment of minor ailments
vii) Referral services
viii) Non-formal education on health and nutrition to women
ix) Preschool education to children 3–6-year-old and
x) Convergence of other supportive services like water, sanitation, etc.
The services are extended to the target community at a focal point ‘Anganwadi’ (AWC) located within an easy and convenient reach of the community. AWC is managed by an honorary female worker ‘Anganwadi Worker'(AWW). Who is the key community-level functionary? She is a specially selected and trained woman from the local community, educated up to high school.
She undergoes 3 months of training in child development, immunization, personal hygiene, environmental sanitation, breastfeeding. Ante-natal care, treatment of minor ailments and recognition of ‘at risk’ children. She gets a small honorarium as an incentive.
The presence of AWW in the community has a synergistic effect as she liaises between health functionaries and the community. Convergence with health helps achieve better maternal and child health enhances awareness regarding family planning services, treatment of morbidity and reduction of mortality.
AWC serves as a central point for immunization, distribution of vitamin A, iron and folic acid tablets and treatment of minor ailments and first aid.
AWC is also the venue for health-related activities carried out by auxiliary nurse-midwives (ANM). Each AWC looks after a population of approximately 1000 in rural and urban areas and 700 in tribal areas. Presently on an average, there are 125–150 AWCs per project/block .
6 months to 6-year-old children, pregnant and lactating mothers belonging to low-income group families are entitled to avail the facility of CN for 300 days in a year.
300 calories and 8 to 10 g proteins are given to all children below 6 years including those with mild (grade 1 & II) malnutrition while pregnant (3rdtrimester) and lactating mothers (first 6 months of lactation) are given 600 calories and 20 g proteins per day as CN.
The type of food varies from state to state. Usually, it consists of a hot meal cooked at AWC. It contains a combination of pulses, cereals, oil, vegetables, and sugar. Some AWCs provide a ‘ready-to-eat’ meal while some other agencies like CARE, World Food Programme (WFP) are implementing a ‘take-home’ strategy for 2–4 weeks at a time for children under 2 years and pregnant and lactating women.
While the ‘take-home’ practice solves the problem of daily attendance and saves the considerable time of the AWW, there is bound to be sharing of the food and the index beneficiary at best gets only a part of it. Food sharing strengthens the family bonds through it will delay recovery from malnutrition.
Cooking and serving a hot meal at AWC, on the other hand, provides a good opportunity to develop a close rapport with the local women and indulge in non-formal education on health and nutrition. This also provides a good opportunity for community mobilization and participation, though it definitely adds to AWW’s workload.
A flexible approach to suit the local needs appears to be the answer. Improper storage facilities, poor quality, and shortages of CN, erratic food supplies, bad communication, pilferage and other such logistic problems in certain states have been noticed and require corrective administrative measures. (Integrated Child Development Services 2019)