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Chapter: Sociology of Health : Community Health

Integrated Child Development Services in India

Integrated Child Development Services (ICDS), Government of India sponsored programme, is India's primary social welfare scheme to tackle malnutrition and health problems in children below 6 years of age and their mothers.

Integrated Child Development Services in India:


Integrated Child Development Services (ICDS), Government of India sponsored programme, is India's primary social welfare scheme to tackle malnutrition and health problems in children below 6 years of age and their mothers. The main beneficiaries of the programme were aimed to be the children below 6 years of age, pregnant and lactating mothers, and adolescent girls. The gender promotion of the girl child by trying to bring her at par with the male child is a key component of the scheme.


Majority of children in India have underprivileged childhoods starting from birth. The infant mortality rate of Indian children is 44 and the underfive mortality rate is 93 and 25% of newborn children are underweight among other nutritional, immunization and educational deficiencies of children in India. Figures for India are substantially worse than the developing country average.


Given such a daunting challenge, ICDS was first launched in 1975 in accordance to the National Policy for Children in India. Over the years it has grown into one of the largest integrated family and community welfare schemes in the world. Given its effectiveness over the last few decades, Government of India has committed towards ensuring universal availability of the programme.


·             Objectives:


The predefined objectives of ICDS are:


·              To raise the health and nutritional level of poor Indian children below 6 years of age


·              To create a base for proper mental, physical and social development of children in India


·              To reduce instances of mortality, malnutrition and school dropouts among Indian Children


·              To coordinate activities of policy formulation and implementation among all departments of various ministries involved in the different government programmes and schemes aimed at child development across India.


·              To provide health and nutritional information and education to mothers of young children to enhance child rearing capabilities of mothers in country of India


·              To provide nutritional food to the mothers of young children & also at the time of pregnancy period.


Scope of Services:


The following services are sponsored under ICDS to help achieve its objectives:


·              Immunization


·              Supplementary nutrition


·              Health checkup


·              Referral services


·              Preschool non formal education


·              Nutrition and Health information




·              For nutritional purposes ICDS provides 300 calories (with 810 grams of protein) every day to every child below 6 years of age. For adolescent girls it is up to 500 calories with up to 25 grams of protein every day.




·              Delivery of services under ICDS scheme is managed in an integrated manner through Anganwadicentres, its workers and helpers. The services of Immunization, Health Checkup and Referral Services delivered through Public Health Infrastructure under the Ministry of Health and Family Welfare. UNICEF has provided essential supplies for the ICDS scheme since 1975. World Bank has also assisted with the financial and technical support for the programme. The cost of ICDS programme averages $10–$22 per child a year. The scheme is Centrally sponsored with the state governments contributing up to 1.00 (1.7¢ US) per day per child.




·              Furthermore, in 2008, the GOI adopted the World Health Organization (WHO) standards for measuring and monitoring the child growth and development, both for the ICDS and the National Rural Health Mission (NRHM). These standards were developed by WHO through an intensive study of six developing countries since 1997.

They are known as New WHO Child Growth Standard and measure of physical growth, nutritional status and motor development of children from birth to 5 years age.



Funding Pattern:


ICDS is a Centrallysponsored Scheme implemented through the State Governments/UT Administrations. Prior to 200506, 100% financial assistance for inputs other than supplementary nutrition, which the States were to provide out of their own resources, was being provided by the Government of India. Since many States were not providing adequately for supplementary nutrition in view of resource constraints, it was decided in 200506 to support to States up to 50% of the financial norms or to support 50% of expenditure incurred by them on supplementary nutrition, whichever is less.


From the financial year 200910, Government of India has modified the funding pattern of ICDS between Centre and States. The sharing pattern of supplementary nutrition in respect of Northeastern States between Centre and States has been changed from 50:50 to 90:10 ratio. So far as other States and UTs, the existing sharing pattern of 50:50 continues. However, for all other components of ICDS, the ratio has been modified to 90:10(100% Central Assistance earlier).



The ICDS team:


The ICDS team comprises the Anganwadi Workers, Anganwadi Helpers, Supervisors, Child Development Project Officers (CDPOs) and District Programme Officers (DPOs). Anganwadi Worker, a lady selected from the local community, is a community based frontline honorary worker of the ICDS Programme. She is also an agent of social change, mobilizing community support for better care of young children, girls and women. Besides, the medical officers, Auxiliary Nurse Midwife (ANM) and Accredited Social Health Activist (ASHA) form a team with the ICDS functionaries to achieve convergence of different services.


Role & responsibilities of AWW, ANM and ASHA:


Role and responsibilities of AWW, ANM & ASHA have been clearly delineated and circulated to States/UTs under the joint signature of Secretary, MWCD and Secretary, MHFW, vide D.O. No. R. 14011/9/2005NRHM –I (pt) dated 20 January 2006.


Status of anganwadi workers and helpers:


Anganwadi Workers (AWWs) &Anganwadi Helpers (AWHs), being honorary workers, are paid a monthly honoraria as decided by the Government from time to time. Government of India has enhanced the honoraria of these Workers, w.e.f. 1.4.2008 by Rs.500 above the last honorarium drawn by Anganwadi Workers (AWWs) and by Rs.250 of the last honorarium drawn by Helpers of AWCs and Workers of MiniAWCs. Prior to enhancement, AWWs were being paid a monthly honoraria ranging from Rs. 938/ to Rs. 1063/ per month depending on their educational qualifications and experience. Similarly, AWHs were being paid monthly honoraria of Rs. 500/ In addition to the honoraria paid by the Government of India, many States/UTs are also giving monetary incentives to these workers out of their own resources for additional functions assigned under other Schemes.


ICDS Training Programme:


Training and capacity building is the most crucial element in the ICDS Scheme, as the achievement of the programme goals largely depends upon the effectiveness of frontline workers in improving service delivery under the programme. Since inception of the ICDS scheme, the Government of India has formulated a comprehensive training strategy for the ICDS functionaries. Training under ICDS scheme is a continuous programme and is implemented through 35 States/UTs and National Institute of Public Cooperation and Child Development (NIPCCD) and its four regional centres.



During the 11th Five Year Plan, the Government of India has laid much emphasis on strengthening the training component of ICDS in order to improve the service delivery mechanism and accelerate better programme outcomes. An allocation of Rs. 500 crore has been kept for the ICDS Training Programme during the 11th Five Year Plan.



Financial norms relating to training of various ICDS functionaries and trainers have been revised upwardly with effect from 1 April 2009.


·              Existing Monitoring System under ICDS Scheme:


Central Level:


Ministry of Women and Child Development (MWCD) has the overall responsibility of monitoring the ICDS scheme. There exists a Central Level ICDS Monitoring Unit in the Ministry which is responsible for collection and analysis of the periodic work reports received from the States in the prescribed formats


State Level:


Various quantitative inputs captured through CDPO’s MPR/ HPR are compiled at the State level for all Projects in the State. No technical staff has been sanctioned for the state for programme monitoring. CDPO’s MPR capture information on number of beneficiaries for supplementary nutrition, preschool education, field visit to AWCs by ICDS functionaries like Supervisors, CDPO/ ACDPO etc., information on number of meeting on nutrition and health education (NHED) and vacancy position of ICDS functionaries etc.


Block Level:


At block level, Child Development Project Officer (CDPO) is the incharge of an ICDS Project. CDPO’s MPR and HPR have been prescribed at block level. These CDPO’s MPR/ HPR formats have onetoone correspondence with AWW’s MPR/ HPR. CDPO’s MPR consists vacancy position of ICDS functionaries at block and AWC levels. At block level, no technical post of officials has been sanctioned under the scheme for monitoring. However, one post of statistical Assistant./ Assistant is sanctioned at block level to consolidate the MPR/ HPR data. In between CDPO and AWW, there exist a supervisor who is required to supervise 25 AWC on an average. CDPO is required to send the Monthly Progress Report (MPR) by 7th day of the following month to State Government. Similarly, CDPO is required to send Halfyearly Progress Report (HPR) to State by 7th April and 7th October every year.


Village Level (Anganwadi Level):


At the grassroot level, delivery of various services to target groups is given at the Anganwadi Centre (AWC). An AWC is managed by an honorary Anganwadi Worker (AWW) and an honorary Anganwadi Helper (AWH).



In the existing Management Information System, records and registers are prescribed at the Anganwadi level i.e. at village level. The Monthly and Halfyearly Progress Reports of Anganwadi Worker have also been prescribed. The monthly progress report of AWW capture information on population details, births and deaths of children, maternal deaths, no. of children attended AWC for supplementary nutrition and preschool education, nutritional status of children by weight for age, information on nutrition and health education and home visits by AWW. Similarly, AWW’s Half yearly Progress Report capture data on literacy standard of AWW, training details of AWW, increase/ decrease in weight of children, details on space for storing ration at AWC, availability of health cards, availability of registers, availability of growth charts etc.


AWW is required to send this Monthly Progress Report (MPR) by 5th day of following month to CDPO’ Incharge of an ICDS Project. Similarly, AWW is required to send Half yearly Progress Report (HPR) to CDPO by 5th April and 5th October every year.


·             Impact:


By end of 2014, the programme was claimed to reach 80.6 lakh expectant and lactating mothers along with 3.93 crore children (under 6 years of age).There are 6,719 operational projects with 1,241,749 operational Aanganwadicentres. Several positive benefits of the programme have been documented and reported.

A study in states of Tamil Nadu, Andhra Pradesh and Karnataka demonstrated significant improvement in the mental and social development of all children irrespective of their gender.


A 1992 study of National Institute of Public Cooperation and Child Development confirmed improvements in birthweight and infant mortality of Indian children along with improved immunization and nutrition.


·              Introduction of WHO growth standard in ICDS:


The World Health Organization (WHO) based on the results of an intensive study initiated in 1997 in six countries including India has developed New International Standards for assessing the physical growth, nutritional status and motor development of children from birth to 5 years age. The Ministry of Women and Child Development and Ministry of Health have adopted the New WHO Child Growth Standard in India on 15th of August, 2008 for monitoring the Growth of Children through ICDS and NRHM.


·             Drawback:


However, World Bank has also highlighted certain key shortcomings of the programme including inability to target the girl child improvements, participation of wealthier children more than the poorer children and lowest level of funding for the poorest and the most undernourished states of India.


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