ICDS: Need for Restructuring

          The Integrated Child Development Scheme (ICDS), launched in 1975, aims at the following objectives: -

• To improve the health and nutrition status of children 0-6 years by providing supplementary food and by coordinating with state health departments to ensure delivery of required health inputs;
• To provide conditions necessary for pre-school children’s' psychological and social development through early stimulation and education;
• To provide pregnant and lactating women with food supplements;
• To enhance the mother's ability to provide proper child care through health and nutrition education;
• To achieve effective coordination of policy and implementation among the various departments to promote child development.

          This is done through a package of six services: health check-ups, immunization, referral services, supplementary feeding, non-formal pre-school education, and advice on health and nutrition.      The anganwadi workers (AWN) provide supplementary food to children under 6 years of age, pregnant and nursing women, pre-school education to children between 3 and 6 years of age and health and nutrition education. Health and family welfare workers (ANM) deliver a package of services including immunization, health check-up, and organise referral services.

          The Department of Women and Child Development (WCD), is the nodal agency responsible for implementation of the National Nutrition Policy (NNP), and is committed to improve the nutritional status of the population and thus reduce the incidence of malnutrition prevalent amongst pre-school children, adolescent girls, expectant and nursing mothers. The scheme of Integrated Child Development Services (ICDS) extends a package of essential services comprising supplementary nutrition, immunization, health check-up, referral services, pre-school education and nutrition and health education to children and expectant and nursing mothers.

          The ICDS, which has been in existence for over four decades, was intended to address the problem of child and maternal malnutrition, but has clearly had limited impact. Malnutrition sets in in-utero and is likely to intensify during the 0–3 year period, if not addressed. A child malnourished during 0–3 years will be marred physically and mentally for life. The design of the scheme has to address this problem frontally. The mother’s malnutrition has knock-on effects on the child’s malnutrition. Exclusive breastfeeding for six months is necessary to avoid unnecessary infections to the baby, develop the baby’s immunity, and ensure growth. The baby must begin to receive solid, mushy food at 6 months (i.e. together with breastfeeds) to continue to grow in the way nature intended her to grow.

           India faces today what is known as the triple burden of malnutrition—the coexistence of inadequate calorie intake and under-nutrition among a large section of the population, excess intake of dietary energy leading to obesity and related health issues among another section of the population, and pervasive micronutrient deficiencies. Evidence from both nationally representative surveys as well as smaller studies underscores these phenomena.

          As for child nutritional status and child-mortality rate, India is doing worse than some Sub-Saharan African countries and south Asian neighbours. Close to 45 per cent are stunted and 23 per cent wasted, with an overwhelming 79 per cent of children aged between 3 months and 3 years being anaemic. While each aspect of the triple burden of malnutrition is relevant and demands specific attention, the prevalence of under-nutrition and micronutrient deficiencies among vast numbers of people despite impressive economic growth remains among the most important challenges for policy-makers.

          The South Asian Enigma (levels of malnutrition in South Asia are higher than in Africa) is well known. India has malnutrition levels almost the levels double those of many countries in Africa. This problem needs a multi-disciplinary approach covering diet diversification including micronutrients, women’s empowerment, education, health, safe drinking water, sanitation, and hygiene.

Reasons for lack of improvement in Nutritional status in ICDS areas include: Inadequate coverage of children below three years of age who are at greatest risk of malnutrition; Irregularity of food deliveries to anganwadis and hence irregular feeding and inadequate rations; Poor nutrition education (of mothers and communities) to improve feeding practices at home; Inadequate training of workers in nutrition, growth monitoring, and communication; Poor supervision Poor co-ordination and linkage with health workers Lack of community ownership and participation

The National Nutrition Policy

          The National Nutrition Policy adopted in 1993 advocates a comprehensive inter-sectoral strategy for alleviating the multi-faceted problem of malnutrition and achieving an optimal state of nutrition for all sections of the society. The Policy seeks to strike a balance between the short term measures like direct nutrition interventions and the long-term measures like institutional/structural changes and thus create an enabling environment and necessary conditions for improving nutritional and health status.

          The National Nutrition Goals envisaged under the Policy to be achieved include: reduction in the incidence of moderate and severe malnutrition among pre-school children by half; reduction in the chronic under-nutrition and stunted growth among children; reduction in the incidence of low birth weight to less than 10 percent; elimination of blindness due to Vitamin "A" deficiency; reduction in the iron deficiency anaemia among pregnant women to 25%; universal iodization of salt for reduction of iodine deficiency disorders to below the endemic level; due emphasis to geriatric nutrition; annual production of 250 million tonnes of food grains; improving household food security through poverty alleviation programmes; and promoting appropriate diets and healthy lifestyles.

National Nutrition Policy

Direct Short Term Interventions	Indirect Long Term Interventions
Universalisation of ICDS Nutrition education of mother Better coverage of expectant women Reaching the adolescent girls Control and elimination of micronutrient malnutrition Popularisation of low cost nutritious foods Fortification of food Universal coverage of IFA, Vit. A and IDD Control Programme	Ensuring household food security Improving dietary pattern Improving purchasing power Strengthening PDS Land Reforms Better health and family welfare coverage Basic nutrition and health education Nutrition surveillance Information, education and communication Research Education and literacy Improving status of women

         

          Experience gained during the last two decades indicate that the most needy may not access the facility and even when they do, the food provided acts more as a substitute than as a supplement. The beneficiaries receive the supplements through ICDS infrastructure, which is funded by the Dept. of Women and Child Development. The State Government and UTs meet the cost of food supplements through the State Plan budget. The funding constraints in the states come in the way of regular assured supply of food to the anganwadis. The inputs from the health sector are often suboptimal; referral care for those with severe under-nutrition is often not available. The ICDS scheme accordingly needs to be restructured in a manner that addresses some of the weaknesses that have emerged and renders it suitable for universalization. The programme must effectively integrate the different elements that affect nutrition and reflect the different needs of children in different age groups.