Integrated Child Development Scheme тАУ the progress of childrenтАЩs health in India
Integrated Child Development Scheme тАУ the progress of childrenтАЩs health in India
Painting a picture of progress:
Health indicators are often used as a benchmark of a nationтАЩs progress, and more often, statistics related to the health of childrenтАУmalnutrition, maternal and infant mortality being some common reference points. Home to the largest number of children, India has long since declared the health and nutrition of children a national priority. This commitment dates back to the first National Policy for Children of 1974, after which the Government launched the Integrated Child Development Scheme (ICDS) in 1975.
Even today the ICDS is considered the flagship national scheme that looks at the health of children under 6 years as well as pregnant mothers across the country. It isтАЬone of the largest and the longest running child development programmes in the world,тАЭ according to our Twelfth Five Year Plan.In 2000, India also ratified the United Nations Millennium Development Goals, which place a special emphasis on the welfare of children, to whom the future belongs.Two of the goals we adopted are related to child and maternal health, with the same common reference points as the quantitative benchmarks here: reducing under-five mortality by two-thirds, and maternal mortality by three-quarters, from what they were in 1990.
These targets of course can only provide larger framework for where we may want to position ourselves as a nation. But, it is the implementation of social policies and programmes that can ultimately determine how and whether we will actually achieve these goals. Replies to several Parliamentary Questions that have been asked on the ICDS,throw upsome of the larger challenges that remain unaddressed our national discourse on maternal and child health.
The ICDS & Implementation Challenges
The ICDS faces several challenges on implementation. Anganwadi Centers (AWCs), which are responsible for delivering the ICDS services,have still not been set up in several districts.Despite the number of operational Anganwadis having increased over time, there are still 50,000 incomplete AWCs across the country, the highest of which are in Bihar and Chhattisgarh тАУ these two states account for approximately half the pending projects in the country, as per data released by the Ministry Of Child and Women Development (MoCWD) in 2012.
The MoCWD also released a number of тАШpending ICDS projects,тАЩ which is significantly lower than that of Anganwadi CentersтАУonly 70projects are pending in this category. The detail of what constitutes an ICDS Project, versus an AWC, is not included along with this information. The C.A.G.тАЩs Audit of the ICDS in 2012-2013 however sheds some light on this. 100 AWCs function under each ICDS projects, according to the CAG Report. For each pending ICDS project in a state, one can then assume that almost a 100 AWCs are pending as well. This would explain why the number of pending AWCs remains much higher.
Understaffing of AWCs also remains an issue. Each AWC is supposed to have one Anganwadi Worker and one Anganwadi Helper, while mini-anganwadi centers have just one Anganwadi worker. Currently there are over 54,000 vacant positions for Anganwadi Workers, and almost 90,000 for Helpers, according to data released in the reply to a Parliamentary Question. While the state-wise details for this have not been released in the reply, the earlier ICDS Tables released by the MoCWD findssome of the highest vacant posts to be in West Bengal and Chhattisgarh for both Anganwadi Workers, and Helpers. Moreover, the CAG Report, which looks at irregularities in the ICDS system found that the number of AWCs functioning without an Anganwadi Worker or Helper has increased considerably over the last five years. In 2007 where close to 30,000 centers did not have a Worker, this has increased almost three fold to over 87,000. Expansion of this scheme has therefore not led to higher recruitment of staff to actually manage the scheme effectively. The consistent absence of critical staff at operational projects indicates that the expansion of ICDS to more and new areas is ineffective, as the report points out.
Infrastructure and human┬аresources two┬аof the┬аprimary areas┬аwhere the CAG Report identifies challenges and irregularities in the ICDS programme. 61 per cent of the AWCs selected for the auditтАУacross 67 districts in 13 states- did not have a separate building, while over half did not have basic┬аfacilities like┬аdrinking water and toilets. Here Andhra Pradesh was found to have the highest deficiencies highest proportion, followed by Bihar and Jharkhand. Far from meeting the criteria laid down by the Ministry, which outline a detailed set of services and infrastructural requirements that AWCs are supposed to adhere to, these statistics point to some glaring deficiencies in the programme.
Restructuring the ICDS
There has been much talk on restructuring the ICDSтАУ several of these steps have been highlighted in replies to Parliamentary Questions, based on a Report by an Inter Ministerial Group that was chaired by the Planning Commission Member in charge of Women and Child Development. The proposal to strengthen and restructure the scheme has been approved for the 12th Five Year Plan, for which a total budget of over one lakh crore has been allocated. Several of the reforms can help address some of these challenges тАУconvergence with other flagship schemes, like the National Rural Health Mission, Total Sanitation Campaign and Sarva Shiksha Abhiyan can help strengthen the coverage of the scheme, if resources are pooled correctly. Similarly, the provision for construction and improvement of buildings and AWCs is crucial for improving the programmeтАЩs infrastructure.
While concrete action to be taken on these fronts can perhaps deliver better outcomes, a lot of the steps to restructure the programme also seek enhance the number of services offered at AWCs as well as recruit additional staff to each center. For instance there is a provision for an additional тАЬAnganwadi worker cum Nutrition Counsellor for focus on children less than 3 years.тАЭ Additional funds are also being released to implement the ICDS Systems Strengthening and Nutrition Improvement Project (ISSNIP) before addressing the challenges that even the rudimentary version of this scheme continues to grapple with.
The ICDS, like a lot of Centrally Sponsored Schemes,continues to face challenges where the Central Government formulates guidelines and outlay structures, and State Governments are responsible for their ground level implementation. ┬аA more frequent and institutionalised mechanism for monitoring the outcomes of these programmes is perhaps needed to ensure that services are actually reaching the intended beneficiaries. Several complaints are received each year with respect to irregularities in the scheme, procurement, distribution of supplementary nutrition, which are forwarded to the concerned States and Union Territories to take action. 69 such complaints were received in 2012, out of which the highest were received from Uttar Pradesh (23) and Bihar (13).
You can read the replies to Parliamentary Questions on the ICDS here, and here.
[ICDS is the second of a four-part series called тАЬQuestions & Answers,тАЭ which highlights information from Parliamentary Questions asked by M.P. Jayant Chaudhary in 2012-2013, written by Saanya Gulati].
Saanya Gulati Worked as a LAMP Fellow at PRS Legislative Research
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