integrated child development services scheme

Dr Soni Rani, PGTKatihar Medical College, Katihar

Introduction

• Children in the age group 0-6 years constitute around 158 million of the population of India (2011 census).

• These Children are the future human resource of the country.

• Ministry of Women and Child Development is implementing various schemes for welfare, development and protection of children.

Department Of Women and Child development

• Integrated child development services (ICDS) scheme.

• Nutrition programme for adolescent girls.

• Nutrition Advocacy and Awareness General Programs for Food and Nutrition Board (FNB)

• Follow up action on National Nutrition Policy 1993

Introduction

• Launched on 2nd October, 1975, the Integrated Child Development Services (ICDS) Scheme is one of the flagship programmes of the Government of India and represents one of the world’s largest and unique programmes for early childhood care and development.

• It is the symbol of country’s commitment to its children and nursing mothers to providing pre-school non-formal education on one hand and breaking the vicious cycle of malnutrition, morbidity, reduced learning capacity and mortality on the other.

Objectives

1. To improve the nutritional and health status of children in the age-group 0-6 years;

2. To lay the foundation for proper psychological, physical and social development of the child;

3. To reduce the incidence of mortality, morbidity, malnutrition and school dropout;

Objectives

4. To achieve effective co-ordination of policy and implementation amongst the various departments to promote child development; and

5. To enhance the capability of the mother to look after the normal health and nutritional needs of the child through proper nutrition and health education.

Beneficiaries

The beneficiaries under the Scheme are

1. children in the age group of 0-6 years,

2. Pregnant women

3. lactating mothers

4. women in 15-45 years age group and

5. adolescent girls. ( Selected Blocks)

Beneficiary and Services

• 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.

• Health check-us supplementary nutrition, health education

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

• supplementary nutrition, health check-ups, immunization, referral services, non formal education

• supplementary nutrition, health education

BENEFICIARY SERVICES

Population Norms under ICDS

For AWCs in Rural/Urban Projects

400-800 - 1 AWCc

800-1600- 2 AWCs

1600-2400- 3 AWCs

Thereafter in multiples of 800- 1 AWC.

Population Norms under ICDS

For Mini AWC 150-400- 1 Mini AWCFor Tribal/Riverine/Desert, Hilly and other

difficult areas/ Projects• 300-800- 1 AWC• For Mini AWC• 150-300- 1 AWCAnganwadi on Demand (AOD)

Where a settlement has at least 40 children under 6 years of age but no AWC

Funding Pattern

• Prior to 2005-06, providing of supplementary nutrition was the responsibility of the States and administrative cost was provided by the Government of India as 100% central assistance.

• The nutrition costs were meager and coverage of the programme in all villages/habitations was also limited and not universal.

Funding Pattern

• Since many States were not providing adequate supplementary nutrition in view of resource constraints, it was decided in 2005-06 to support the States/UTs up to 50% of the financial norms or to support 50% of expenditure incurred by them on supplementary nutrition, whichever is less.

• Since 2009- 10, Government of India has modified the sharing pattern of the ICDS Scheme between the Centre and States.

Funding Pattern

• The sharing pattern of supplementary nutrition in respect of North Eastern States between Centre and States has been changed from 50:50 to 90:10 ratios.

• In respect of other States/UTs, the existing sharing pattern in respect of supplementary nutrition is 50:50.

• The existing cost sharing ratio for other components is 90:10 except the new components approved under Strengthening & Restructuring for which it is 75:25 (90:10 for NER).

THE ICDS TEAM ( District)

The ICDS team comprises the

• Anganwadi Workers(AWW)

• Anganwadi Helpers (Sahayika)

• Supervisors(LS)

• Child Development Project Officers (CDPOs)

• District Programme Officers (DPOs).

Anganwadi Worker:

• AWW maintains the growth chart of every child and weighs each child under the age of 3 years each month.

• Children over the age of 3 years are assessed with an upper mid-arm circumference (MUAC).

• She organizes non-formal education for children of 3-6 years age group.

Anganwadi Worker:

• She teaches mothers on health and nutrition.

• She coordinates with PHC staff for the health checkup, immunization and referral of suffering children.

• She provides treatment of minor illnesses.

• She carries out a quick sample survey of the area and families to find out the total beneficiaries.

Anganwadi Worker:

• She maintains all files and records of services provided and growth of the children and submit the report every month to MukhyaSevika.

• She organizes supplementary nutrition feeding for children (0-6 years) and expectant and lactating mothers by planning a menu based on locally available foods.

Lady Supervisor/ Mukhya Sewika (MS)

• She is a full time worker who supervises the work of 20, 25 and 17 anganwadi workers in urban, rural and tribal projects respectively.

• She visits each anganwadi at least once a month, and coordinates with lady health visitor in nutritional and health activities.

Child Development Project Officer (CDPO)

• For one project there is one CDPO who covers one community development block having a population of 80,000 to 120,000.

• S(h)e supervises, coordinates and guides the work of entire ICDS project as an in-charge and supervises 4-5 Mukhya Sevikas.

• He/she is assisted by one assistant CDPO.

Role of the Health Department

a) Health checkup

b) Handling the referrals from Anganwadi,

c) Immunization is carried out by health workers female,

Role of the Health Department

d) Health and nutritional education,

e) Continuing education of ICDS staff, and

f) Monitoring of the health component of ICDS.

SERVICES UNDER ICDS

Services Target Group Services Provided By

Supplementary Nutrition

BeneficiaryRevised Rate( Per

beneficiary per day)

Calorie/Day Protein( g)/Day

Children (6-72months) 6.00 500 12-15

severely underweight Children (6-72months)

9.00 800 20-25

Pregnant women and Nursing

Mother7.00 600 18-20

Revised Nutrition and Feeding Norms under Supplemtary Nutrition Component of ICDS

• Provision of supplementary nutrition under the ICDS Scheme is primarily made to bridge the gap between the Recommended Dietary Allowance (RDA) and the Average Daily Intake (ADI) of children and pregnant and lactating women.

• Under the revised Nutritional and Feeding norms which have been made effective from February 2009, State Governments/UTs have been requested to provide 300 days of supplementary food to the beneficiaries in a year which would entail giving more than one meal to the children from 3 to 6 years who visit AWCs.

Revised Nutrition and Feeding Norms

• This includes morning snacks in the form of milk/banana/egg/seasonal fruits/micronutrient fortified food followed by a hot cooked meal (HCM).

• For children below 3 years of age, pregnant and lactating mothers, Take Home Rations (THRs) in the form of premixes/ ready to eat food are provided.

• Besides, for severely underweight children in the age group of 6 months to 6 years, additional food items in the form of micronutrient fortified food and/or energy dense food as THR is provided.

• These norms have also been endorsed by the Supreme Court in order dated 22.04.2009.

Other schemes implemented through ICDS.

• Kishori Shakti Yojana

• The Rajiv Gandhi Scheme for Empowerment of Adolescent Girls (RGSEAG)- Sabla

• Indira Gandhi Matritva Sahyog Yojana (IGMSY)

Kishori Shakti Yojana

• This scheme is a redesign of already existing adolescent girls scheme which was being implemented in 507 ICDS blocks.

• The Objectives are-1. To improve the nutritional and health status of girls in the

age group of 11-18 years; 2. To provide the required literacy and numeracy skills

through the non-formal stream of education, to stimulate a desire for more social exposure and knowledge and to help them improve their decision making capabilities

3. To train and equip the adolescent girls to improve/ upgrade home-based and vocational skills;

Kishori Shakti Yojana

4. to promote awareness of health, hygiene, nutrition and family welfare, home management and child care, and to take all measure as to facilitate their marrying only after attaining the age of 18 years and if possible, even later;

5. to gain a better understanding of their environment related social issues and the impact on their lives; and

6. to encourage adolescent girls to initiate various activities to be productive and useful members of the society.

The Rajiv Gandhi Scheme for Empowerment ofAdolescent Girls (RGSEAG)- Sabla

• The objectives of the program are:

• Enable the Adolescent girls for self-development and empowerment

• Improve their nutrition and health status.

• Promote awareness about health, hygiene, nutrition, adolescent reproductive and sexual health (ARSH) and family and child care.

The Rajiv Gandhi Scheme for Empowerment ofAdolescent Girls (RGSEAG)- Sabla

• Upgrade home-based skills, life skills and integrate with the National Skill Development Program (NSDP) for vocational skills.

• Mainstream out of school adolescent girls into formal/ non formal education.

• Provide information/guidance about existing public services such as PHC, CHC, Post Office, Bank, Police Station, etc.

RGSEAG- Sabla

• An integrated package of services is to be provided to adolescent girls as follows:

1. Nutrition provision

2. Iron and Folic Acid (IF A) supplementation

3. Health check-up and Referral services

4. Nutrition & Health Education (NHE)

RGSEAG- Sabla

5. Counseling/Guidance on family welfare, ARSH. child care practices and home management

6. Life Skill Education and accessing public services

7. Vocational training for girls aged 16 and above under NSDP.

Indira Gandhi Matritva Sahyog Yojana(IGMSY)

Objectives of IGMSY:

• To improve the health and nutrition status of Pregnant and Lactating (P & L) women and their young infants by:

1) Promoting appropriate practices, care and service utilization during pregnancy, safe delivery and lactation.

2) Encouraging women to follow (optimal) Infant and Young Child Feeding (IYCF) practices including early and exclusive breastfeeding for the first six months.

3) Contributing to better enabling environment by providing cash incentives for improved health and nutrition to pregnant and lactating women.


• Target beneficiaries:

1. P & L women of 19 years of age and above for their first 2 live births.

2. All Government/Public Sector Undertakings (Central and State) employees are excluded from the Scheme as they are entitled for paid maternity leave. The wives of such employees are also excluded from the Scheme.


3. Age, number of live births and employment status would be as reported by the beneficiary. In case of wrongful claim by the beneficiary, the amount paid to her would be recovered. Failing which, she will be liable for prosecution.

4. Pregnant and lactating AWWs and AWHs may also avail the benefit under the Scheme if they are not receiving paid maternity benefits from the Government.


• Amount of payment and conditionality:

• The beneficiary will receive a total cash incentive of 4000 in three installments, subject to the fulfillment of specific conditions.

• First Installment:

• Amount: 1500. Given only at the end of the 2nd trimester of pregnancy i.e., completion of six months of pregnancy, on fulfillment of all the five conditions mentioned below:

1. Pregnancy registered within 4 months at the AWC or Health Centre (Sub-centre/ PHC/ CHC/ district hospital/ empanelled private doctor under JSY).

2. Received at least one antenatal check-up (out of optimal 3).

3. Received IFA tablets.

4. Received at least one TT vaccination (out of optimal 2).

5. Received at least one counseling session at the AWC/ Village Health and Nutrition Day (VHND)/Home Visit.

• Second Installment:

• Amount: 1500. Given only at the end of three months of delivery on fulfilment of all the six conditions mentioned below:

1. Child birth is registered.2. Child has received Polio and BCG vaccination.3. Child has received Polio and DPT-1 vaccination.4. Child has received Polio and DPT-2 vaccination.5. Child has been weighed at least two times after

birth (out of optimal 4 times including weighing at birth).

6. After delivery, mother has attended at least two IYCF counseling sessions at the AWC/VHND/Home Visit (out of optimal 3 times).

• Third Installment:

• Amount: 1000. Given only when the infant completes six months of age, on fulfilment of all the five conditions mentioned below:

1. Child has been exclusively breastfed for first six months, unless contraindicated by a medical doctor.

2. Child has been introduced complementary foods on completion of age six months.

3. Child has received Polio and DPT-3 vaccination.

4. Child has been weighed at least two times between age 3 and 6 months (out of optimal 3)

5. Mother has attended at least two IYCF counseling sessions between 3 and 6 months of lactation, at the AWC/VHND/Home Visit (out of optimal 3).

• Special conditions:

1. If the beneficiary fulfils the conditions for the 1st installment, but undergoes a miscarriage she may be given the 1st installment upon producing proper documentation.

2. In the first year of implementation (i.e., up to March 2011), the beneficiary can be enrolled at any stage of pregnancy or lactation.

3. From 2011-12 onwards, a woman has to be enrolled in the Scheme from the stage of pregnancy, preferably within 4 months of pregnancy, to avail the benefit of the Scheme unless she gives reasons as to why she was left out or did not register at AWC.

3. The beneficiary will be given the 1st installment only after the 2nd trimester is completed even if the beneficiary has fulfilled the conditions for the 1st installment earlier.

4. If the beneficiary has a still birth, she will be eligible for the 2nd installment subject to attending 2 counseling sessions for her own health and well being.

5. If the beneficiary fulfills the conditions for the 2nd installment but the infant does not survive between birth and 3 months of age, she will be given the 2nd installment, upon producing proper documentation to ensure it was not a case of infanticide especially for the girl child.

6. If the beneficiary on her first delivery gives birth to live twins she can avail the benefit of the Scheme only once (since the wage loss and rest required would be only once).

7. If the beneficiary has one child and then in second delivery gives birth to twins she can avail the benefit of the Scheme for the second time (even though there are now 3 children).

8. Beneficiary can receive the cash benefit of the Scheme only from the AWC where the beneficiary is registered

Evaluation of ICDS

• Conducted by NCAER( National Council For Applied Economic Research).

• High performing states are- Andhra Pradesh, Assam, Chhattisgarh, Gujarat, Himachal Pradesh, Jammu and Kashmir, Jharkhand, Karnataka, Kerala, Tamil nadu, Uttarakhandand West Bengal.

• Poor performing states are- Bihar, Haryana, Rajasthan and Uttar Pradesh.

Evaluation of ICDS

• 49% of eligible group is registered for ICDS benefits.

• About 64% of children receive SNP out of total children registered by AWW.

• Around 78% of pregnant and lactating women and 42% of adolescent girls are recorded in delivery register.

• Overall 42.5% of AWWs have their own building, 17.4% were in rented building, 17.3% were in primary school building and 22.9% running in Panchayat Bhawan, AWW own house.

Evaluation of ICDS

• 87% of AWW have drinking water supply, 69% functional weighing scale.

• About 94% of AWW adequately trained for preschool education.

• ICDS programme has positive impact on Immunization coverage at national level.

Major Achievements Of ICDS

• Expenditure on the program was 3,103.08 croresin 2007-08 and 4,306.82 crores in 2009-10.

• As against 2.27 crore beneficiaries until March 1997, there were 7.95 crore children below 6 years and 1.84 crore pregnant and lactating mothers beneficiaries in by Oct 2011.

• I 2.86 lakh anganwadi centers (AWC) are operational and up to 1.2lakhs AWCs more bring set up.

Major Achievements Of ICDS (2012-13)

• WHO growth Charts

• Mother and Child Protection card (MCP Card)

• Interactive voice response system

• ICDS system strengthening and nutrition improvement projects( ISSNIP)

Strengthening and Restructuring of ICDS( 12th five year Plan)

• Repositioning the AWC as a vibrant, child friendly BCD centre (Baal Vikas Kendra) which will ultimately be owned by women in the community.

• This will have expanded/redesigned services, extended duration (6 hours), with an additional AWW provided initially in 200 high burden districts and with piloting of crèche services in 5 percent of AWCs.

Strengthening and Restructuring of ICDS

• These would function as the first village outpost for health, nutrition, early learning and other women and child related services.

• This would include the provision of adequate infrastructure, facilities such as safe drinking water, toilets, hygienic SNP arrangements, wall painting, play space and a joyful early learning environment including provision for activity corners, and anchoring of other services for maternal, child and care for out of school adolescent girls through the Rajiv Gandhi Scheme for Empowerment of Adolescent Girls.


• Re-designing and reinforcing of the package of ICDS services, including a new component of Child Care and Nutrition Counseling for mothers of children under three years.

• Enhancing Nutritional Impact with revised nutrition and feeding norms; ensuring provision for nutritious, freshly cooked, culturally appropriate meal, (morning) snack and Take Home Rations in harmony with Supreme Court directives and the IMS (and its Amendment)Act and greater involvement of women's SHGs.


• Piloting of community kitchens and joint kitchens with Mid Day Meals will also be undertaken.

• An innovative new component is SNEHA SHIVIRS for promoting community based prevention and care of severely undernourished children, backed by stronger referral linkages with the health system (Nutrition Rehabilitation Centres under NRHM).


• Sneha Shivirs include 12 day Nutrition Care and Counselling Sessions at AWCs, using positive role model mothers, whose children are growing well, for demonstrating positive care practices, cooking and feeding, (with mothers‘ contribution} to mothers of undernourished children in similar community environments.

• Indira Gandhi Matritva Sahyog Yojana(IGMSY)-the Conditional Maternity Benefit Scheme will be expanded in the Twelfth Plan.


• Strengthening Early Childhood Care and Education (ECCE) by redefining ICDS non formal preschool education to ECCD, with additional and trained human resources, introduction of a developmentally appropriate curriculum framework with joyful learning methodologies.

• Ensuring convergence with related sectors such as NRHM, TSC, NRDWP, SSA, MGNREGA through joint planning, inclusion of young child related concerns in State/District Annual Programme.

• Implementation Plans (APIPs) of relevant sectors, joint monitoring of key results and indicators and defined roles and accountabilities.


• Institutional Reforms aim at transforming ICDS into a "Mission Mode." decentralized program.

• Strengthening of ICDS Management Information System (MIS).

• Integrated Child Development Services Systems• Strengthening and Nutrition Improvement

Project (ISSNIP) will also be implemented in 162 high burden districts of 8 states, reinforcing the strengthening and restructuring ICDS, and enhancing child nutrition and development outcomes.

THANKS

integrated child development services scheme

Health & Medicine