His name is ‘Today’ We are guilty of many errors and many faults, but our worst crime is abandoning the children, neglecting the fountain of life. Many of the things we need can wait. The child cannot. Right now is the time his bones are being formed, his blood is being made, and his senses are being developed. To him we cannot answer ‘Tomorrow,’ his name is today. - Gabriela Mistral

INTEGRATED CHILD DEVELOPMENT SERVICES Dr Subodh S Gupta

Integrated Child Development Services  India’s response to the challenge of meeting the needs of its children  To break vicious cycle of malnutrition  To promote child development  Largest public initiative in the world (1975)  One of the eight flagship programs of GOI

Objectives of ICDS  Lay the foundation for proper psychological development of the child  Improve nutritional & health status of children 0-6 years  Reduce incidence of mortality, morbidity, malnutrition and school drop-outs  Enhance the capability of the mother and family to look after the health, nutritional and development needs of the child  Achieve effective coordination of policy and implementation among various departments to promote child development

Beneficiaries  Children in age-group 0-6 years  Pregnant and lactating women  Women in the reproductive age-group  Adolescent girls

Intergenerational cycle of malnutrition

7 national economy

Services provided  Nutrition  Supplementary nutrition  Growth monitoring and promotion  Micronutrient supplementation/ promotion  Pre-school non-formal education  Health  Immunization  Periodic health check-up  Referral services  Nutrition and health education

Target Group & Services under ICDS

Supplementary Nutrition BeneficiariesCalories (cal) Protein (g) Children 6 month – 6 years Severely malnourished children (6 months – 6 years) Pregnant & Lactating Mothers

Mother and Child Protection Card

13 Why focus on early child development?  Brain development is most rapid and vulnerable from conception to five years  The factors known to affect child development are common, especially in low/middle income countries  Impaired child development has life-long effects  Interventions in early childhood are more cost effective than at other ages

14 Pathways to poor development

15 Early childhood Inadequate nutrition Inadequate stimulation Birth Poor obstetric care Delayed initiation of breast feeding Pregnancy Poor maternal nutrition Domestic violence Psychosocial stimulation Maternal mental health promotion Nutritional supplementation Improved obstetric and early newborn care Breast-feeding support Improved antenatal care Improved maternal nutrition Interventions for violence Pregnancy

16 Child growth Child development Nutrition Maternal competence

Population Norms  One AWC for every 800 population  For Rural/ Urban Projects  400 – 800 – 1 AWC; – 2 AWCs  – 1 Mini AWC  Tribal/ Desert/ Hilly areas  300 – 800 – 1 AWC  – 1 Mini AWC

Coverage with ICDS ICDS ProjectsApprox 7073 Operational AWCApprox 14 Lakhs

Other approaches  Rajiv Gandhi National Crèche Scheme for Working Mothers  Initiatives by Non-government  Ruchika, SEWA, Nutan Bal Sangh  ECE Centers in Private Sector  Courses in Early Childhood Care and Development

Three Mismatches in ICDS  Service Mismatch  Beneficiary mismatch  Need mismatch

Challenges faced in the present interventions  Poor quality of child development services  Overburden on the ICDS  Capacity of Child Care Workers  Not recognized as skilled work  Unavailability of trained manpower in ECCD  Poor attention to age-group 0-3 years  Involvement of the family and community  Minimum standards and regulatory mechanisms  No viable information on indicators of ECCD  Poor documentation of efforts in Voluntary sector

Restructuring of ICDS Scheme (Programmatic reforms)  Repositioning AWC as a vibrant child friendly ECD center (Bal Vikas Kendra)  Extended duration of functioning  Additional AWW in 200 high burden  Piloting of crèche service in 5% AWC  Greater ownership of women and communities  Provision of adequate infrastructure  Facilities; e.g. safe drinking water, toilets, hygienic SNP arrangements, wall painting, play space & a joyful learning environment  Other services for adolescent girls (SABLA Yojana)

Restructuring of ICDS Scheme  Redesigning & reinforcing of the package of ICDS services, including a new component  New component of child care & nutrition counseling by regular and prioritized visiting at critical contact points for improving maternal care & nutrition, IYCF  Enhancing nutritional impacts with revised nutrition and feeding norms  Joint kitchens with mid-day meal  Continuum of care  Community-based prevention and care of Severely underweight children

Restructuring of ICDS Scheme (Management reforms)  Community mobilization and monitoring  Improved human resources  Training and capacity building  Strengthening civil society partnerships  Increased public accountability by strengthening role of PRIs, VHNSCs  Convergence with related sectors  Strengthened monitoring system

Restructuring of ICDS Scheme (Institutional reforms)  ICDS missions at different levels  Setting up of national/ State ICDS Mission resource centers  Living Universities  Community ownership  Accreditation system  Focused attention  Increased NGO participation  Service standards

Supreme Court Order (Nov 2001)  Each child up to 6 years of age to get 300 calories and 8-10 grams of protein;  Each adolescent girl to get 500 calories and grams of protein;  Each pregnant woman and each nursing mother to get 500 calories and grams of protein;  Each malnourished child to get 600 calories and grams of protein;  Have a disbursement centre in every settlement.

Supreme Court Order (2004)  File within 3 months an affidavit stating the period within which it proposes to increase the number of AWCs to cover the 14 lac habitations.  Revision of the norm of Re. 1 and Incorporate their suggestion in the affidavit.  All SC/ST hamlets/inhabitations in the country have Anganwadi Centres as early as possible.  All the State Governments/Union Territories shall allocate funds for ICDS on the basis of norms fixed  BPL shall not be used as eligibility criteria for ICDS".