ICDS – Launched on 2nd October 1975

Intergenerational cycle of Malnutrition

Source : ACC/SCN, Second report of the World Nutrition Situation: Vol:1: Global and Regional Results. ACC/SCN, Geneva, 1992.

Child growth failure

Early pregnancy

Small adult women

Low weight and height in teenagers

Low birth weight baby

Restructuring ICDS for Achieving Nutritional Goals

Sumanta Chakraborty

1st Year PGT, Department of Community MedicineSession (2015-2018)

Moderator

Dr. Nilanjana Ghosh Assistant Professor, Department of Community Medicine

North Bengal Medical College & Hospital

Target groupsBeneficiary Services

Pregnant women Health check-ups, TT, supplementary nutrition, health education

Nursing mothers Health check-us supplementary nutrition, health education

Children less than 3 years

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

Children 3-6 years

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

Adolescent girls(11-18 years)

Supplementary nutrition, health education

I. Current Situation Analysis

Nutritional status of the children under 3 years of age

Stunted Wasted Underweight0

10

20

30

40

50

60

51

20

4345

23

40

32.5

20.3

31.5

Under nutrition in children under 3 years

NFHS-2 NFHS-3 NFHS-4

Nutritional status of the child

Perc

enta

ge

Situation of anaemia in children (6-59) months of age

0

10

20

30

40

50

60

70

8074

61

54.2

Anaemia in children (6 – 59) months of age

Anaemia

Perc

enta

ge

Recommended and Actual Breastfeeding Practices

Indices Goal Achievement

Initiation of breastfeeding within 1 hour of birth

100% 47.5%

No pre-lacteal feeding 100% 43%

Exclusive breast feeding 100% 52.3%

Nutritional goals under Twelfth five year plan (2012-2017)

Indicator Current level NFHS 4 (2015 - 2016)

Twelfth Plan Goal (2012 – 2017)

1.Prevalence of malnutrition in children (0-3 years) of age

31.5% 50% of NFHS 3 (2005-2006) level i.e., 20%

2.Prevalence of anaemia among women (15-49 years) of age

62.5% 28%

Three Decades of ICDS – Appraisal by NIPCCD (2006)

• 59% AWCs - no toilet facility• 17% AWCs - unsatisfactory toilet facility• 75% AWCs - pucca buildings• 44% AWCs - lacking PSE kits• 46.31 days - Disruption of supplementary nutrition at AWCs• Major reasons causing disruption was reported as delay in supply of items of supplementary nutrition

Cont.. • 36.5% - Mothers did not report weighing of new born children• 29 % - Children were of Low Birth weight• 37 % - AWWs reported non-availability of materials/aids for Nutrition and Health Education (NHED)

Emerging Issues and Gaps

• Challenges of Universalisation

• Gaps:-

I. Programmatic gapsII. Operational gaps

II. ICDS restructuring

Government of India approved the proposal for Strengthening and Restructuring of ICDS scheme with an over-all budget allocation of Rs. 1,23,580 crores during the 12th Five Year Plan primarily due to:

• Addressing various programmatic, management and institutional gaps • Meeting the administrative challenges that had crept the ICDS over the years

The administrative approvals in this regard have since been issued to all the States/UTs

ICDS System Strengthening and Nutrition Improvement Project (ISSNIP) was approved by World Bank to credit a loan of US$ 106 million to Ministry of Women and Child Welfare, Government of India

Restructured ICDS rolled out in Mission mode in 3 phases:

2012-2013 – 200 High burden districts

2013-2014 – 200 additional districts including districts from special category states (J&K, Uttarakhand, H.P) and NER

2014-2015 – 243 remaining districts w.e.f. 1st April 2014 of the 12th five year plan

III. Goals of ICDS restructuring

To target 3 main outcomes namely:-1. Prevent & reduce young child under-nutrition (% of underweight children 0-3 years) by 10 percentage point2. Enhance early development and learning outcomes in all children (0-6) years of age3. Improve care and nutrition of girls and women, reduce anaemia prevalence in young children, girls and women by one fifth

Contribute towards reduction in IMR, MMR, LBW and CSR in convergence with other National Health Policies

IV. Objectives of ICDS restructuring and Mission

• To institutionalise essential services and strengthen structures at all levels

• To enhance capacities at all level

• To ensure appropriate inter-sectoral response at all level

• To raise public awareness and participation

• To create data base and knowledge for child development services

V. Focus of ICDS restructuring and Mission

• To decide and mention all activities with their physical and financial targets with the revised cost norms

• Tracking of expenditures against physical targets

• Monitor the programme performance effectively and take necessary mid-course corrections

• Strengthen the existing monitoring mechanism

• Strengthening of existing program management to accelerate program outcomes

VI. Programmatic Reforms

Programmatic Reforms under Mission

• Construction of AWC buildings has been introduced, a provision for construction of 2 lakh AWCs @ Rs. 4.5 lakh per unit

• Repositioning the AWC as a vibrant ECCED centre (Bal Vikas Kendra) & first village level out post for Health, Nutrition and Early Learning

• Action plan for opening up AWCs - minimum of 6 hours daily

• Provision for additional AWW cum Nutrition Counsellor

• Action plan for construction of AWCs with revised cost norms and finalization of timeline

• State initiative for improving SNP with revision of cost norms

• State proposal for upgradation, maintenance, improvement and repair of AWC building

• Action plan for strengthening of Training System

• Plan for Setting up of State Training Cell at Directorate level

• Forging strong institutional and programmatic convergence particularly, at the district, block and village levels

• Models providing flexibility at local levels for community participation

• Inter-sectoral convergence with other departments such as NHM, SSA, MGNREGA etc.

• Introduction of State/District Annual Programme Implementation Plan (APIPs) of relevant sectors, joint monitoring of key results and indicators and defined roles and accountabilities

• Allocating adequate financial resources for other components including Monitoring and Management Information System (MIS)

• Training and use of Information and Communication Technology (ICT)

• Expansion of Rajiv Gandhi Scheme for Empowerment of Adolescent Girls (SABLA) and Indira Gandhi Matritva Sahyog Yojana (IGMSY)

Reaching children under 3yrs, pregnant women & lactating mothers

• Home based care and nutrition counselling for pregnant and lactating mother and mothers of children under 3 years of age

• Action plan for engaging of additional worker in all ICDS projects

• Improve growth monitoring by WHO growth chart and counselling

• Mother, child tracking through self monitoring and use of family retained joint MCP Card

• Stronger referral linkages with Health by using joint MCP Card as a referral Card

• Early stimulation programme for under 3 years to foster their holistic development

VII. Revision of Norms

Revision of Norms: SNPCategory Existing Norms

(w.e.f. 16.10.08) Approved norms effective from the date of approval as per phasing plan(per beneficiary per day)

(i) Children (6-72 months) Rs.4.00 Rs.6.00

(ii) Severely underweight children (6-72 months)

Rs.6.00 Rs.9.00

(iii) Pregnant women and Nursing mothers

Rs.5.00 Rs.7.00

Revision of norms: Others

• Pre School Education Kits• Medicine kits • Monitoring • Rent revisions• Maintenance (of existing Government owned & non rental AWC buildings)• Improvement & Up gradation of building for other facilities (kitchen, store, ANC facility etc.)• Provisions for nutritious, freshly cooked, culturally appropriate meal, morning

snacks and take home rations• Involvement of women SHGs• Additional rooms for Crèche

• Other existing norms of ICDS Scheme shall continue in existing form

VIII. New provisions under ICDS Mission

• SnehaShivir: for community/family care for moderately malnourished children in minority, tea garden, urban slums• Linkages with NRC- Facility based care for SAM

• ECCED (Bal Vikas Diwas) every month at AWCs –1. For conducting parenting sessions 2. For improving early child care3. For early stimulation to children under three years 4. Focus to children with special needs

Cont..

• AWC cum Crèche centres for working mothers of unorganised sectors, specifically in urban slums, tea garden etc. in at least 5% of total AWCs

• Additional space & worker for longer working hours (6 hrs)

• Accreditation of AWCs as well as AWTC/MLTC proposed

IX. Initiatives

Examples States

IYCF messages through Annaprasana A.P., M.P., Gujarat

GMIS/GIS A.P., Gujarat, T.N.

Accreditation of AWCs A.P, Karnataka, U.P, W.B.

Annual ECCED Monthly Bal Sabha

Karnataka, GujaratM.P.

Community Monitoring Bal Vikas Samiti PRI involvement Community score cards

KarnatakaRajasthanJharkhand

Pushtir laddu for underweight children W.B.

WHO Growth Chart Mother and Child Protection Card

ECCED Sneha Shivir

X. Innovations & Good practices

Strengthening Monitoring & Evaluation

• Revised MIS implemented in all districts by September 2013• District level master training underway• Strengthening VHSNC in coordination with NHM is underway • DSW preparing guidelines for monitoring VHND with DSWO/CDPOs and Supervisors• Piloting social audits & establishing grievance redressal cells• Creating Field Learning Sites (FLS) as peer learning model in 10% of total AWC

Application from National to Village level

Improvement in community participation

• Rolling out of Mother’s Support Group or Matri Sahayak Gut in all functional AWCs• Increasing involvement of AWCMC members in AWC monitoring through capacity building in selected districts• System for fund transfer to all AWCMC for SNP initiated in all states

since 2011-12• Proposing audit of AWCMC in phased manner for removing the bottlenecks and ensuring quality SNP• Model AWC: Adoption of 10 AWC by CDPOs

Improvement in IYCF & Combat child malnutrition

• Release of State IYCF guidelines• Training cum counselling tool in local language• Special Project for reducing under five malnutrition in selected districts• Scaling up of “Pratham Ahhar” to introduce complementary feeding for improving IYCF• Implementation of WIFS, bi-annual de-worming & vitamin A prophylaxis in the

AWCs• Scaling up “Matri Amrit” to strengthen ANC services and counselling to pregnant mother for safe delivery and breast feeding• Scaling up concept of Kitchen gardens in all AWCs

XI. Outline for setting up the institutional arrangements at the village / ward level

Community

AWC

Sneha shivir

NRC

VHNDRegular services

Growth Monitoring

Take home messages : • Continuous ongoing process improving with each implementation in accordance to defined objectives and missions

• Initially launched on 2nd October 1975• Restructuring started in phased manner • Strives to mend existing gaps and meet challenges • Core areas of restructuring and innovations mainly deal with Sneha Shivir, ECCED, WIFS, AWC Creche and many others

• All programs and missions if work in synchrony and interdependently may lead to our common vision: A healthy India

ICDS paving way for reaching SDG 1,2,4,5 ?

ICDS

1.End poverty in all its forms everywhere2. End hunger, achieve food security and improved nutrition and promote sustainable agriculture4. Ensure inclusive and equitable quality education and promote life-long learning opportunities for all5.Achieve gender equity and empower all women and girls

Thank you

References

1. Second report of the World Nutrition Situation: Vol: 1: Global and regional results. ACC/SCN, Geneva, 19922. ICDS MISSION - The Broad Framework for implementation, Ministry of women and child development, Government of India3. Operational Guidelines on Facility Based Management of Children with Severe Acute Malnutrition, Ministry of Health and Family WelfareGovernment of India, 20114. NFHS-2 fact sheets of West Bengal5. NFHS-3 fact sheets of West Bengal6. NFHS-4 fact sheets of West Bengal7. Sustainable Development Goals8. Twelfth five year plan 2012-20179. National nutritional policy