Bottlenecks of ICDSDr Rajesh Kumar Ludam

PG StudentDept of Community Medicine

V.S.S.M.C.H , Odisha

Every fifth young child in the world lives in India

Every second young child in India is malnourished

Three out of four young children in India are anaemicEvery second newborn in India is at risk of reduced learning capacity due to iodine deficiencyMalnutrition limits development potential and active learning capacity of the child

Introduction-:Worlds largest and unique early

childhood development programme of its kind.

Introduced on an experimental basis on 2nd October 1975 in 33 project blocks.

The outreach of ICDS services has increased enormously.

Nutritional and developmental needs of children below six years, pregnant and lactating mothers.

7025 projects and 13,31,076 AWC’s are operational in 35 States/UTs

927.66 lakh beneficiaries under supplementary nutrition and 346.66 lakh 3-6 yr children under pre-school education component.

Cost sharing between the Centre and State-: - 90:10 for all components including SNP for

NE - 50:50 for SNP and 90:10 for all other

components for states other than NEKey functionary is AWW & Overall

responsibilities lies with the CDPO.

Objectives-: Improve the nutrition and health status

of the children.Foundations for proper physical, social

and psychological development.Reduce the incidence of

morbidity,mortality,malnutrition and school dropouts.

Achieve effective coordination and amongst the various departments .

Enhance capability of the mother to look after normal health and nutritional needs of child.

THE TARGET GROUPS

Pregnant women

Nursing Mothers

Children less than 3 years

Children between 3-6 years

Adolescent girls( 11-18 years)

Health check-ups, TT, supplementary nutrition, health education.

Same as pregnant mothers except TT.

supplementary nutrition, health check-ups, immunization, referral services

Same as children below 3 years + non formal education

supplementary nutrition, health education

BENEFICIARY SERVICES

Positive Outcomes-:Birth rate & IMR has decreased significantly.Under-five years mortality has also

decreased.Percentage of children in severe grades of

malnutrition has declined.School enrolment and performance of

children is better.School drop out has reduced.Immunisation status of the beneficiaries has

been improved.Burden of Blindness and Anaemia has also

decreased.

:-BOTTLENECKS-:Defective Policy Development--Incomplete mapping and ground verification.-Lack of comprehensive program

implementation guidelines-Inadequate operational efficiency &

accountability -Improper fund transfer mechanism-Non-revision & indexation of cost to rising

prices.-Low focus on growth monitoring- Inadequate fund for community mobilization

by IEC.

INFRASTRUCTURE AND EQUIPMENT-:Failure to sanction of req no. of AWCs &

also to operationalise even the sanctioned ones.

Delay in construction of AWC building.A study by NIPCCD reveals 42.5% of

sampled AWCs had their own building,17.4% were in rented,17,3% in primary schools.

Countrywide around 75% of AWCs have Pucca structure.

Necessary equipments, furniture, utensils are lacking

69% of sampled AWCs have functional baby weighing scale

87% have drinking water supply with a little information regarding its hygiene.

Less than 50% have toilet facility.Lack of functional computers, printers

and vehicles.

HUMAN RESOURCE-:• Shortage of nearly 30% of CDPO and 29% of

supervisors• Those who are present only 70% are

trained.• Almost all AWWs are in position but about

80% of them are matriculated or above• One third of them have in-service training.• A study from AP reported most supervisors

have average job performance • Posting of AWH is also disappointing.

SUPPLEMENTARY NUTRITION AND GROWTH MONITORING-:

- The NCAER study reports about 60% registration.

- Review in Rajasthan found nearly 92% women getting the benefits but the food served is stale.

- Evaluation in J&K,WB,MP,UP,Bihar reported children not weighted regularly with about 60% coverage.

- Per beneficiary per day expenditure remain low compared to stipulated norms.

- Improper storage of the supplies and unhealthy cooking environment

- Evaluation report of planning commission showed 64% of registered received food 16 days/M.

IMMUNISATION-:- Study in Chandigarh reports TT Coverage

about 70% in pregnant women - Evaluation in J&K 91% for polio and DPT,

89% BCG,74% for measles.- Centre for Child Rights discovered >50% not

fully immunized ,14% were never immunized.- Poor awareness of people, non co-operation

of staffs, disbeliefs are major hurdles for 100% immunization.

Non formal pre school education-:No data of eligible beneficiaries and also

implementation plan.Average attendance found on three successive visits

by research team was 14.A study in WB reported that majority of parents

send their children for food rather than PSE.A report from Odisha in 2007 covering 12 villages

found that pre-school education was present in only one village.

Pre school education quality are also compromised as reported by various studies.

Health check-up and referral-:As per an evaluation by planning commission in

2011 health check ups are provided by nearly 70% and referral by around 50% AWCs across country.

A review by UNICEF and Gram-Sabha stated health check-ups and distribution of medicines were irregular in Bihar.

UNESCO found these to be the weakest link of ICDS due to lack of community participation and health staffs.

Nutritional Health Education-:Not effective because of-: -Faulty service and providers -Lack of active participation of women -Literacy status of women -Religious constraints -False Beliefs

Monitoring & Evaluation-:- Vacancy in supervisory staff resulting in

deficient reporting at field level.- The M&E unit of Ministry don’t have fully

reliable data.- The State visits of officers and their

corrective action reports are not properly documented.

- Insufficient action taken by the Ministry to address the reported shortcomings through performance audit by C & A G.

Summary-:1. Inadequate emphasis on Nutrition and Health

Education (NHE) activities for behavior change2. The focus and coverage of children in 0-3 years of

age is inadequate.3. Lack of effective co-ordination between Health

and ICDS functionaries.4. Irregular supply of Supplementary Food due to

administrative reasons.5. Programmatic emphasis on Community

participation is poor.

6.The quality of training of Anganwadi workers needs improvement.

7. The referral system is weak.8. Home visits by AWWs are infrequent.9. There is inadequate decentralization; i.e. the same

guidelines of Government of India are followed all over the country.

10. AWW has not been accorded the dignity and prestige as a voluntary worker.

11. Failure to promote effective community leadership and participation.

12. The role of supervisor is marginal and the CDPO’s skills require improvement

CHALLENGE-: To harmonize the geographic expansion

along with an improved implementation strategy to accelerate better & visible programme outcome….