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

INTEGRATEDCHILDDEVELOPMENTSERVICES

Dr Subodh S Gupta

Integrated Child Development ServicesIndias response to the challenge of meeting the needs of its children To break vicious cycle of malnutrition To promote child developmentLargest public initiative in the world (1975)One of the eight flagship programs of GOI

Objectives of ICDSLay the foundation for proper psychological development of the childImprove nutritional & health status of children 0-6 yearsReduce incidence of mortality, morbidity, malnutrition and school drop-outsEnhance the capability of the mother and family to look after the health, nutritional and development needs of the childAchieve effective coordination of policy and implementation among various departments to promote child development

BeneficiariesChildren in age-group 0-6 yearsPregnant and lactating womenWomen in the reproductive age-groupAdolescent girls

Intergenerational cycle of malnutrition

*nationaleconomy

Childpoor early development

poor school achievementbehavioural problems

poor stimulation, nutrition & health

Intergenerational transmission of poverty

adultlow educational attainment low skilled job / no work high fertilitydepressed/stressed

Services providedNutritionSupplementary nutritionGrowth monitoring and promotionMicronutrient supplementation/ promotionPre-school non-formal educationHealthImmunizationPeriodic health check-upReferral servicesNutrition and health education

Target Group & Services under ICDS

Sheet1

ServicesTarget GroupAccountability

Pre-School EducationChildren 3-6 yearsAWW

Growth monitoringChildren below 6 yearsAWW

Supplementary NutritionChildren below 6 years; Preg & Lact MotherAWW & AWH

Micronutrient supplementation/ promotionChildren below 6 years; Preg & Lact MotherANM /MO

Immunization*Children below 6 years; Preg & Lact MotherANM /MO

Health Check-up*Children below 6 years; Preg & Lact MotherANM / MO/ AWW

Referral ServicesChildren below 6 years; Preg & Lact MotherAWW /ANM /MO

Nutrition & Health EducationWomen (15-45 years)AWW/ ANM/ MO

Sheet2

Sheet3

Supplementary Nutrition

BeneficiariesCalories (cal)Protein (g)Children 6 month 6 years 50012-15Severely malnourished children (6 months 6 years)80020-25Pregnant & Lactating Mothers60018-20

Mother and Child Protection Card

Mother and Child Protection Card

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

*Pathways to poor development

*Pregnancy

*

Population NormsOne AWC for every 800 populationFor Rural/ Urban Projects400 800 1 AWC; 800-1600 2 AWCs150-400 1 Mini AWCTribal/ Desert/ Hilly areas300 800 1 AWC150-300 1 Mini AWC

Coverage with ICDS

ICDS ProjectsApprox 7073Operational AWCApprox 14 Lakhs

Other approachesRajiv Gandhi National Crche Scheme for Working MothersInitiatives by Non-governmentRuchika, SEWA, Nutan Bal SanghECE Centers in Private SectorCourses in Early Childhood Care and Development

Three Mismatches in ICDSService MismatchBeneficiary mismatchNeed mismatch

Challenges faced in the present interventionsPoor quality of child development servicesOverburden on the ICDSCapacity of Child Care Workers Not recognized as skilled workUnavailability of trained manpower in ECCDPoor attention to age-group 0-3 years Involvement of the family and communityMinimum standards and regulatory mechanismsNo viable information on indicators of ECCDPoor 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 functioningAdditional AWW in 200 high burdenPiloting of crche service in 5% AWCGreater ownership of women and communitiesProvision of adequate infrastructureFacilities; e.g. safe drinking water, toilets, hygienic SNP arrangements, wall painting, play space & a joyful learning environmentOther services for adolescent girls (SABLA Yojana)

Restructuring of ICDS SchemeRedesigning & 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, IYCFEnhancing nutritional impacts with revised nutrition and feeding normsJoint kitchens with mid-day mealContinuum of careCommunity-based prevention and care of Severely underweight children

Restructuring of ICDS Scheme (Management reforms)Community mobilization and monitoringImproved human resourcesTraining and capacity buildingStrengthening civil society partnershipsIncreased public accountability by strengthening role of PRIs, VHNSCsConvergence with related sectorsStrengthened monitoring system

Restructuring of ICDS Scheme (Institutional reforms)ICDS missions at different levelsSetting up of national/ State ICDS Mission resource centersLiving UniversitiesCommunity ownershipAccreditation systemFocused attentionIncreased NGO participationService 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 20-25 grams of protein;Each pregnant woman and each nursing mother to get 500 calories and 20-25 grams of protein;Each malnourished child to get 600 calories and 16-20 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 fixedBPL shall not be used as eligibility criteria for ICDS".

India is the home to the largest child population in the world. The development of children is the first priority on the countrys development agenda, not because they are the most vulnerable, but because they are our supreme assets and also the future human resources of the country. In these words, our Tenth Five Year Plan (2002-07) underlines the fact that the future of India lies in the future of Indian children across income groups, geographical locations, gender and communities.*Launched on2ndOctober 1975 in 33 Community Development Blocks, ICDS today represents one of the worlds largest programmes for early childhood development. ICDS is the foremost symbol of Indias commitment to her children Indias response to the challenge of providing pre-school education on one hand and breaking the vicious cycle of malnutrition, morbidity, reduced learning capacity and mortality, on the other.

It is an inter-sectoral programme which seeks to directly reach out to children, below six years, especially from vulnerable and remote areas and give them a head-start by providing an integrated programme of early childhood education, health and nutrition. No programme on Early Childhood Care and Education can succeed unless mothers are also brought within it ambit as it is in the lap of the mother that human beings learn the first lessons in life. **The past few decades have also witnessed an unprecedented expansion of early childhood initiatives in the country. Together with major public initiatives like ICDS, a remarkable expansion has taken place primarily in private sector, which has played

Small efforts are being made by several Non-governmental organizations in different parts of the countries. Their assimilated experiences will be valuable to guide any future childhood development programs.

The trend of initiating courses in Early childhood through several universities (including open universities) have contributed to greater interest, awareness regarding early childhood development and made it a happening area. *All the programs at village converge at the level of Anganwadi center. However, this has resulted in an increased burden of tasks on the Anganwadi workers and consequently diluted the child development component which was main focus in the initial vision of ICDS.

A major problem is that ECE is not considered a skilled job. Even after 35 years of launching ICDS, the country does not have a pool of manpower trained in ECCD or ECE.

Absence of ECE as a subject in most of the Indian Universities.

There is a need to improve Intersectoral coordination needs and advocacy efforts with policy makers and planners. *