IT HAPPENS ONLY IN INDIA,
GREAT JOB MR. PARMAR
it is good to eat as many as vegetables and fruits (totally vegetarian), but my aurvedic doctor asked me to stop eating every...
Inter-ministerial report calls for improving infrastructure and facilities at anganwadi centres
The world’s largest community-based outreach programme for early childhood development is set to undergo a makeover, if the inter-ministerial group on ICDS restructuring has its way.
The group, chaired by Syeda Hameed, member Planning Commission, submitted the report to prime minister’s office in September 2011 and later to the ministry of women and child development for implementation. It has recently been uploaded on the Planning Commission website.
The ambitious Integrated Child Development Services (ICDS) reaches out to 80 million children in India under the age of six, and 18 million pregnant and breastfeeding mothers through close to 1.3 million anganwadi centres. The scheme provides supplementary nutrition, pre-school education, health and immunisation.
The trigger to reform the three-decade-old programme was the HUNGaMA report released by the prime minister in January 2010, where he described malnutrition a “national shame”. The report which surveyed 112 districts in nine states showed 42 per cent of children were undernourished, prompting calls for a serious review of ICDS.
Subsequently, ideas for revamping the scheme—a major emphasis in the 11th Five Year Plan—were discussed at a multi-stakeholder nutrition retreat anchored by the Planning Commission in August 2010, following which it was referred to the National Council on India’s Nutritional Challenge, chaired by the prime minister in November 2010. Later, an inter-ministerial group on ICDS restructuring was formed in June 2011; it had the mandate to draw up a comprehensive strategy in consultation with the National Advisory Council. The inter-ministerial group, comprised members from various ministries, including women and child development, health and family welfare, drinking water and sanitation, panchayati raj, and ministry of human resource development.
The report attempts to streamline ICDS reforms in line with the priority initiatives of the 12th Plan, which has set an ambitious target for universal ICDS coverage to 14 lakh households. It estimates a massive expenditure of Rs 1,83,778 crore in the 12th Plan to effectively implement ICDS in ‘Mission Mode’.
The inter-ministerial report found gaps both in the way the programme was designed and in its implementation. It calls for harmonising ICDS with the draft national food security bill, with provisions suggested by the high-level expert group on universal health coverage, together with the B K Chaturvedi committee on restructuring centrally-sponsored schemes.
The focus is on early childhood development–pregnant and breastfeeding mothers and children under three years old. To enhance nutrition among vulnerable children and mothers, the strategy paper calls for additional anganwadi workers and nutrition counsellors initially in 200 high burden districts, revised nutrition and feeding norms and Sneha Shivirs for community-based care of undernourished children.
Important provisions include early detection of developmental delays in children through regular monitoring growth, home visits by Auxiliary Nurse Midwives (ANMs) and Accredited Social Health Activists (ASHA) workers to families with under nourished children. It also includes child care and nutrition counselling for pregnant and breastfeeding mothers, and community-based care for undernourished children.
It calls for anganwadi centres to remain open for at least six hours and provide almost day-long child care. Crèches will be set up in five per cent of the anganwadi centres.
Infrastructure and facilities at anganwadi centres will be upgraded to include safe drinking water, child friendly toilets, hygienic cooking arrangements and play space for children. Anganwadi centres will also be used for other women and child-related activities—for adolescent girls under the Rajiv Gandhi Scheme for Empowerment of Adolescent Girls, for instance. Mothers and peers are to be roped in as positive role models to demonstrate health and nutrition care at anganwadi centres. Community kitchens will also be piloted and the scheme will create linkages with the mid day meal scheme.
Panchayats and urban local bodies to take centre-stage
The restructuring strategy calls for measures to closely monitor the growth of children. Mothers will be handed out new cards with WHO child growth standards to allow families to track their children’s nutrition and growth.
Child nutrition will be discussed during periodic home visits, and during the ‘monthly fixed village health and nutrition days’; children below will be weighed monthly while 3 to 5 year-olds will be weighed quarterly. Anganwadi, ASHA and ANM workers will be trained on health and nutrition to improve healthcare delivery. Mechanisms to ensure joint reporting and monitoring through common village health sanitation and nutrition committees and anganwadi management committees will be put in place, and stronger referral linkages with health centres will be created.
The strategy also calls for improving the quality of early learning with anganwadi workers trained in appropriate ‘joyful learning approaches’ for children between 3 and 6 years old. A bevy of school readiness interventions in anganwadi centres or in schools are planned for five plus year olds.
Important changes in programme implementation have been suggested to upscale ICDS to ‘mission mode’, signifying a shift from a one-size-fits-all to a more flexible approach tuned to state and district-specific models. Funding will be performance-linked.
A key recommendation is to devolve more power to panchayats and urban local bodies, which are to have the mandate to select anganwadi workers, construct and maintain anganwadi centres, and constitute anganwadi management committees. Common village health, sanitation and nutrition committees are to be instituted and recognised as sub-committee of panchayats.
Likewise, the report recommends that funds of up to 10 per cent of the project are set aside for civil society participation. Mothers and women groups will be roped in for village contact drives. Contributions from local communities for play materials, durries, utensils and kitchen gardens are to be promoted. To ensure quality, a community-owned ICDS accreditation system will be put in place, as will incentives through awards such as the Nirmal Gram Puruskar.
ICDS mission resource centres will be set up at the national and state levels to provide technical and management support to anganwadi workers. Information technology will be deployed to strengthen community-based monitoring of the programme. Mission reviews, social audits and public hearings will improve public accountability of the programme.