The Unfulfilled Potential Of The ICDS

Jayati Ghosh

THIS year marks the 30th anniversary of the Integrated Child Development Scheme, or ICDS, which was initiated in October 1975 in response to the evident problems of persistent hunger and malnutrition especially among children.

Since then, the ICDS has grown to become the world’s largest early child development programme. The coverage of the Scheme has expanded rapidly, especially in recent years. From an initial 33 blocks in 1975, the programme covered an estimated 6,500 blocks by 2004. There are almost 600,000 anganwadi workers and an almost equal number of anganwadi helpers providing services to beneficiaries throughout the country. According to the government, the programme currently reaches 33.2 million children and 6.2 million pregnant and lactating women.

OBJECTIVES AND THE ROLE OF THE ICDS

Officially, the objectives of the Scheme are:

• to improve the nutritional and health status of children in the age group 0-6 years

• to lay the foundation for proper psychological, physical and social development of the child

• to reduce the incidence of mortality, morbidity, malnutrition and school drop out

• to achieve effective coordinated policy and its implementation amongst the various departments to promote child development

• to enhance the capability of the mother to look after the normal health and nutritional needs of the child through proper nutrition and health education

Accordingly, the ICDS involves the setting up of anganwadi centres, each of which is intended to cater to a population of around 1,000 in rural and urban areas and to around 700 in tribal areas. The anganwadi worker and helper, who are the basic functionaries of the ICDS, run the anganwadi centre and implement the Scheme in coordination with the functionaries of the health, education, rural development and other departments. They are called ‘social workers’ and are paid an honorarium of Rs 1,000 per month for the worker and Rs 500, for the helper. However, the supervisors and other higher officials are government employees.

The anganwadis are meant to provide the following services:

• supplementary nutrition to the children below 6 years of age, and nursing and pregnant mothers from low income families

• nutrition and health education to all women in the age group of 15- 45 years

• immunisation of all children less than 6 years of age and immunisation against tetanus for all the expectant mothers

• health check up, which includes antenatal care of expectant mothers, postnatal care of nursing mothers, care of newborn babies and care of all children under 6 years of age

• referral of serious cases of malnutrition or illness to hospitals, upgraded PHCs/ Community Health Services or district hospitals

• non-formal preschool education to children of 3-5 years of age.

ICDS–HOW MUCH SUCCESSFUL

By many accounts, thus far the Scheme has been a success. Most of the studies conducted on the functioning of the ICDS have recognised its positive role in the reduction of infant mortality rate, in improving immunisation rates, in increasing the school enrolment and reducing the school drop out rates. The most important impact of the ICDS is clearly reflected in significant declines in the levels of severely malnourished and moderately malnourished children and Infant Mortality Rate in the country. The percentage of children suffering from severely malnutrition declined from 15.3 per cent during 1976-78 to 8.7 per cent during 1988-90. Infant Mortality Rates declined from 94 per 1000 live births in 1981 to 73 in 1994.

Nevertheless, it is also clear that for a scheme that has been in operation for three decades, the benefits are still far too limited, and maternal and child health and nutrition are still areas of major concern for policy. Even today, around one third of Indian children – and more than half in rural areas - are born with low birth weight. More than 30 per cent of children under 5 years are severely stunted, and around 20 per cent are severely underweight. These indicators are particularly bad in some ostensibly more “developed” and relatively high-income states, such as Gujarat, Maharashtra and Karnataka.

The high incidence of premature births, low birth weight and neonatal and infant mortality can be attributed to poor nutritional conditions of the mothers. The majority of women still do not get proper nutrition and health care during their pregnancy. In some areas, 60-75 per cent of pregnant women receive no antenatal care at all. More than 85 per cent of women in rural areas and 95 per cent in the remote areas give birth at home. Only 42 per cent of women in the country have access to safe delivery facilities.  Surveys indicate that even the immunisation services are still less than desired: around 30 per cent of children in the age group 1-2 years are not adequately immunised.

REASONS FOR THE DISMAL PICTURE

What explains this continuing dismal picture even thirty years after what is one of the more successful of government schemes was launched specifically to address these problems? The basic answer must be that not enough resources have been devoted to this scheme, to meet the huge requirement. Quite simply, there are not enough anganwadis or anganwadi workers, and they do not have adequate resources to meet all the nutritional requirements of those pregnant and lactating mother, infants and small children who need them. If the declared norm of one anganwadi per 1000 population is to be met, there should be 14 lakh anganwadis, as against the current 6.5 lakh such centres, of which only around 6 lakh centres are operational.

There is the further problem of overloading the tasks assigned to anganwadi workers. The worker and helper in such centres are paid so little that they are no more than voluntary workers who receive a paltry “honorarium”, and are called “part-time workers” in the centres which are supposed to open for only four hours a day. Yet they have been found to be among the most dedicated and committed of public servants who have developed grassroots contacts and are able to identify particular individuals and groups in any community easily. They are therefore increasingly engaged in a wide range of other public interventions, especially in the rural areas.

Some of these other jobs in which the anganwadi workers and helpers are involved relate to Health Department services such as creating awareness on diarrhoea and ORS, Upper Respiratory Infections, Directly Observed Treatment System for Tuberculosis, AIDS awareness, motivation and education on birth control methods, etc. There are also additional activities related to the Education Department like Total Literacy Programmes, Sarva Shiksha Abhiyan, DPEP, Non Formal Education, etc.

It is easy to see that all this amounts to more than a full-time activity, yet the anganwadi workers and helpers are hardly compensated for all this. In any case there are simply not enough of them to cater to all of these varied demands even within a small population. The obvious need therefore is to increase the number of such workers and to provide them with higher wages which would reflect all the work that they really do perform.

There are other problems which stem directly from this inadequacy of centres, staff and resources to run this programme effectively. It has been found that one of the primary reasons for poor coverage of needy groups under the scheme is the location of the anganwadi centre, which typically tends to be in the main village or in upper or dominant caste hamlets in rural areas in most states. This restricts the access to such services by deprived communities such as SCs and STs who live slightly apart. Yet these are precisely the groups who require it the most.

There are frequent complaints of the delay in central government transfer of resources for this programme, while state governments differ substantially in the amount and quality of supplementary nutrition that is provided. This makes the ICDS uneven and sometimes even problematic in terms of the quality of food provided and its acceptability to small children.

The original intent of the ICDS programme was to address the various sub-stages (conception- 1 month, < 3 years and 3-6 years) of growth in order to ensure that negative health and nutritional outcomes do not accompany the child from one stage to the next. However, the way the programme has been implemented, it effectively ends up concentrating mainly on the 3-6 years age group. While children under 3 years are usually enrolled in the programme, their involvement remains nominal and there are no facilities to allow for reaching out to such children and their mothers at home in an effective way.

The timing of the anganwadi centres also effectively rules out facilities to many of the poorest households, since they are open only for four hours a day. When both parents are working, which is typically the case among rural labour households in many parts of the country, it is difficult to deliver and pick up the child from the centre in time, and so children in such households get excluded from the services. Once again this really boils down to a question of resources, since these centres should be open for longer with higher associated expenditure.

SUPREME COURT’s INTERVENTION

These problems have long been recognised, and public interest litigation has ensured that some important orders have been passed by the Supreme Court in this regard. In 2001, the Supreme Court directed the state governments and Union Territories to implement the ICDS in full and to ensure that every ICDS disbursing centre in the country provides 300 calories and 8-10 grams of protein for each child up to 6 years of age; 500 calories and 20-25 grams of protein for each adolescent girl; 500 calories & 20-25 grams of protein for each pregnant woman and each nursing mother; and 600 calories and 16-20 grams of protein for each malnourished child. The Court also ordered that there should be a disbursement centre in every settlement.

Despite this court order, the government was slow to act and very little was done to ensure that these demands were met even four years later. However, in the latest Budget speech the finance minister promised to universalise the scheme to ensure that, in every settlement, there is a functional anganwadi that provides full coverage for all children. But the allocation only provides for another 1,88,168 additional centres, which is still well below the requirement. The Centre will also share half of the costs (currently borne by the states) on supplementary nutrition. While this is positive, it is still very inadequate, as the required expansion, in terms of Central allocation of resources and hiring of more workers, is much greater than is being envisaged by the government even now.

In any case, the finance minister’s promise can be seen as a partial attempt to meet the increasing concern of the Supreme Court, which has already twice reprimanded the government for not doing enough to ensure the univeralisation and greater effectiveness of the Scheme. In the latest order, dated October 7, 2004, the Supreme Court issued very detailed and far-reaching instructions, which required universalisation of the scheme, including in all SC/ST habitations, and specifically prohibited the use of targeting to only Below Poverty Line households.

These are extremely important guidelines, yet it is evident that the government is not likely to conform to them without sufficient social and political pressure. Also, the other problems plaguing the ICDS, in terms of inadequate numbers of anganwadi workers and inadequate payments to them, need to increase the functioning hours of the centres, and so on, are still not being addressed. It is a sad commentary on the state of public intervention, that even the most critical schemes that are universally acknowledged to be necessary to ensure the future of the country, must be fought for in courts of law and then insisted upon through activism and people’s struggles.