INTEGRATED CHILD DEVELOPMENT SERVICES (ICDS)

Integrated child development services (ICDS), launched on 2^nd October, 1975, is the earliest comprehensive national health program, which targets holistic development of the child and uses an integrated approach to provide basic services for better child care.

Objectives of ICDS are to:

• Improve nutritional and health status of children lt; 6 years.

• Ensure proper physical, psychological and social development.

• Reduce mortality, morbidity, PEM and school dropouts.

TABLE 28.8: Components of ICDS

P/L: Pregnant and lactating mothers

*Health check-up is provided to all women in reproductive age group (15-44 years), irrespective of pregnancy/lactation status.

• Co-ordinate amongst various departments in child health programs.

• Enhance mother's capability to look after her child's needs through proper nutrition and health education.

Beneficiaries of the program are: (a) children lt;6 years, and (b) women in reproductive age (15-44 years).

Components/services: Six basic services offered under ICDS are enlisted in Table 28.8. In addition, an additional component, i.e. Adolescent girls scheme (Kishori Shakti Yojana) has been included subsequently in selected ICDS blocks, to provide health education, literacy, recreation and skill development services for school drop-out girls (11-18 years age).

Some important services are as follows:

• Supplementary nutrition is provided to all under-6 children, adolescent females and pregnant/lactating (P/L) mothers, using locally available and acceptable hot cooked/ready-to-eat foods. It aims to provide 500 cal with 12-15 gm proteins for 1-6 years children; 600 cal with 18-20 gm proteins to pregnant, lactating (P/L) or adolescent females; and 800 cal with 20-25 gm proteins to severely malnourished children, for minimum 300 days in a year.

• Immunization is provided to children and pregnant mothers as per national immunization schedule and anganwadi workers maintain immunization records of all beneficiaries.

• Health check-up services for children include-regular weight and development monitoring, early diagnosis/ referral/treatment of minor illnesses with simple medications, e.g. PEM, diarrhea, acute respiratory infections, etc. and periodic deworming.

For P/L mothers, regular antenatal checkups are provided at anganwadi centers. These services are provided by local primary health centre/subcentre staff, e.g. ANMs.

• Nutritional/health education under ICDS aims to enhance capability of women in reproductive age group to look-after their own as well as their children's health and nutritional needs. Important components of this education, rendered via group sessions, home visits and demonstrations, include-promotion of breast feeding, family planning, safe hygiene and health-service utilization.

• Non-formal education (early childhood care and preschool education) is the back-bone of ICDS, a strategy to enhance its utilization and facilitate total development of child through early stimulation.

• Referral services based on IMNCI and other relevant guidelines.

Operational aspects: ICDS is a multi-sector program, under the primary responsibility of Department of Women and Child Welfare, Ministry of Human Resources, Government of India. Project is implemented under block-wise administrative units of three types (tribal, rural and urban slum blocks).

Each urban or rural block serves ~1,00,000 population, while a tribal block caters to ~35,000 population. Currently, over 5500 blocks are operational under this scheme.

Anganwadi centers, one per 1000 population, is the most peripheral service center under ICDS scheme, looked after by a local trained women, designated as Anganwadi worker. Each ICDS block is headed by child development project officer (CDPO), supported by medical officer of local health center and other personnel.

Entire expenditure of this scheme is borne by central and state government in 60:40 ratio, while supplementary nutrition component id funded by both as 50:50.

Review Periodic reviews of ICDS projects have shown distinct superiority and benefits on child health indicators over those in Non-ICDS areas. Hence, future thrust is not only directed to expand population coverage, but also to use large network of anganwadi centers and workers as an out-reach point for other national programs.

28.3.4