Introduction:

Children are the future of a nation. Recognizing the importance of children as a vital human resource, the Constitution of India, Directive Principles of State Policy and the National Policy for Children have addressed the need for ensuring holistic development of the child.

As per 2001 census, Haryana has around 3.26 million children, constituting 15.46% of Haryana’s population, who are below the age of 6 years. A large number of them live in economic and social environment which impede the child's physical and mental development. These conditions include poverty, poor environmental sanitation, disease, infection, inadequate access to primary health care, inappropriate child caring and feeding practices. Government of India proclaimed a National Policy on Children in August 1974 declaring children as, "supremely important asset". The policy provided the required framework for assigning priority to different needs of the child.

  INTEGRATED CHILD DEVELOPMENT SERVICES SCHEME 
(ICDS)

The programme of the Integrated Child Development Services (ICDS) was launched on October 2, 1975 in 33 blocks in the country on an experimental basis to commemorate the 106th birth anniversary of the Father of the Nation Mahatma Gandhi seeking to provide an integrated package of services in a convergent manner for the holistic development of the child. In Haryana, ICDS was launched in Kathura block of Sonepat district at first.

ICDS symbolizes the country's commitment to its children.

ICDS promotes child survival and development through an integrated approach for converging basic services for improved child care, early stimulation and learning, improved enrolment and retention, health and nutrition, and water and environmental sanitation.

Integrated and inter-sectoral nature, coordination mechanism, community involvement, training infrastructure and monitoring system make ICDS a unique programme.

ICDS has the potential to achieve the major national nutrition, health and educational goals of the National Plan of Action for Children.

ICDS provides increased opportunities for according children their rights.

ICDS through its advocacy and social mobilization components aims to empower the community using communication channels and media as tools for development.

The Integrated Child Development Services (ICDS) Scheme was conceived with an integrated delivery package of early childhood services so that their synergistic effect can be taken full advantage of . The Scheme aims to improve the nutritional and health status of vulnerable groups including pre-school children, pregnant women and nursing mothers through providing a package of services including supplementary nutrition, pre-school education, immunization, health check up, referral services and nutrition and health education.

In addition, the Scheme envisages effective convergence of inter-sectoral services in the Anganwadi Centres.

Objectives:

The objectives of the scheme are :

To improve the nutritional and Health status of pre-school children in the age- group of 0-6
    years; 

To lay the foundation of proper psychological development of the child;

To reduce the incidence of mortality morbidity, malnutrition and school drop-out;

To achieve effective coordination of policy and implementation amongst the various
    departments  to  promote child development; and

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.

Package of Services :

To achieve the above objectives, the ICDS aims at providing a package of services, consisting of  Supplementary nutrition; Immunization; Health Check-up; Referral Services; Non-formal Pre-school education; and Nutrition & Health Education.

:: ICDS Services ::

1. HEALTH:

i) Immunization:-

Immunization of pregnant women and infants protects children from six vaccine preventable diseases-poliomyelitis, diphtheria , pertussis, tetanus, tuberculosis and measles. These are major preventable causes of child mortality, disability, morbidity and related mal-nutrition. Immunization of pregnant women against tetanus also reduces maternal mortality.

PHC and its subordinate health infrastructure carry out immunization of infants and expectant mothers as per the national immunization schedule. The Anganwadi Worker assists the health functionaries in coverage of the target population for immunization.

                                   DAY OF IMMUNIZATION : Wednesday 

ii) Health Check up:-

Multi-Purpose Health Workers (Female) and Lady Health Visitors, Health Supervisors (Female) pay regular visits to the Anganwadi Centres, where ante-natal care of expecting mothers, post natal care of nursing mothers and health needs of the children upto 6 years of age are attended to.
Medical Officers of the area also carry out health check up of children and mothers periodically.

iii) Referral Services:-

During health check-ups and growth monitoring, sick or malnourished children, in need of prompt medical attention are provided referral services through ICDS.

iv) Treatment of Minor Illnesses:-

Multi Purpose Health Workers (Female)/ Health Supervisors (Female) also diagnose minor ailments and distribute simple medicines in Anganwadi Centres. Each Anganwadi Worker has a small medicine kit with basic medicines for common ailments like fever, cold, cough, diarrhoea, worms, skin and eye infections that she dispenses as and when required.

2. NUTRITION:

This includes supplementary nutrition, growth monitoring and promotion , nutrition and health education and prophylaxis against Vitamin-A deficiency and control of nutritional anaemia .

       ::: Targeted Beneficiaries :::

The Scheme targets the most vulnerable groups of population including children upto 6 years of age, pregnant women and nursing mothers belonging to poorest of the poor families and living in disadvantaged areas including backward rural areas, tribal areas and urban slums. The identification of beneficiaries is done through surveying the community as per guidelines laid down by GOI vide letter No.F.I-22/89-CD dated 11^th January,1990.

ii) Prophylaxis Programme:-

National prophylaxis programme for prevention of blindness caused by Vitamin-A deficiency and control of nutritional anaemia among mothers and children are two direct nutrition interventions integrated in ICDS. The usage of iodised salt is promoted.

iii) Growth monitoring and promotion:-

  Growth monitoring and nutrition surveillance are two important activities, that are in operation at the Anganwadi Level in ICDS. Both are important for assessing the impact of health and nutrition related services.

Children below the age of 3 years are weighed once a month and children 3-6 years of age are weighed quarterly. Weight for age growth Cards are maintained for all children below six years. This helps to detect both growth faltering and also in assessing nutritional status.

iv) Nutrition and Health Education:-

Nutrition and Health Education is a key element of capacity building of women in the age group of 15-45 years so that, they can look after their own health, nutrition and development needs as well as that of their children and families. NHED comprises basic health, nutrition and development information related to child care and development infant feeding practices, utilization of health services, family planning and environmental sanitation. Anganwadi Workers use fix days of immunization, mothers meeting, growth monitoring days, home visits, local festivals/gatherings, days/ weeks like National Nutrition Week and Breast Feeding Week , health and developmental education.

3. Early Childhood Care and Non-Formal Pre-School Education:

The early childhood care and pre-school education component of ICDS scheme is considered the backbone of the ICDS programme. The early childhood pre-school programme aims at providing a learning environment for promotion of social, emotional, cognitive, physical and aesthetic development of the child. Non-formal Pre-school education is provided to 3-6 years children in play way methods for preparing them for formal/ primary schooling.

        ::: Focal Point for Delivery of ICDS services - Anganwadi :::

The programme provides an integrated approach for converging basic services through community-based Anganwadi Workers and helpers, supportive community structures/women's group -through the Anganwadi Centre, the health system and in the community. Besides this, the AW is a meeting ground where women's/mother's group can come together, with other frontline workers, to promote awareness and joint action for child development and women's empowerment.

The population coverage through the Anganwadi Worker is approximately 1000 in rural and urban areas.

    NUTRITIONAL STRATEGY

      Strategy Paper for improving the Nutritional Status of Moderately and severely
      Malnourished Children (0-6 years) of Haryana.

              The ICDS is one of the principal planks in the national’s strategy to provide children from deprived sections of Society basic services for a better start in life.  Starting from 1975, with one block to 100 blocks by 1992-93 and the entire rural area of 111 blocks and 5 urban blocks by 1996-97, ICDS has been providing different services like Supplementary Nutrition, Immunization, Health and Nutrition education, Non-formal pre-school education, Health check ups and referral services to children below 6 years of age and pregnant and nursing mothers and other women in the age group of 15-45 years. However, despite such a vast coverage, where about 90% of the State has been covered for ten years or more, the levels of malnourishment remain very high.  Data for the past ten years shows that there does not appear to be making much headway in tackling the problem of malnourishment in the children of Haryana. For the past 10 years the percentage of moderately malnourished children Grade-II shows no improvement and is stagnant at 20%, one in every five children in Haryana is moderately malnourished.  In absolute terms the number of such children has doubled from about 1.4 lakh in 1991-92 to 2.8 lakh in 2002-03 not a happy sign at all.

            Therefore, there is need to give more focused attention and target the malnourished children and their families in particular on a sustained and continuous basis.To overcome the problem of malnutrition , a strategy has been framed and circulated to all the Programme officers and Child Development Project officers for implementation at the grass root level

            The strategy seeks to, over a period of twelve months or so, significantly reduce the number of Grade-IV, Grade-III and Grade-II children in the State by over 50% to less than half the present levels.

:: STRATEGY FOR IMPROVING THE NUTRITIONAL STATUS ::

A.  Weighment:

      First of all 100% weighing of all children in the project area should be done in the first instance positively by December 31,2002.  All children must be weighed and report be obtained about the status of children. PO’s, CDPO’s, and Supervisors to be personally responsible in their respective areas to ensure that this is done by the time fixed.  Thereafter the children should be weighed at regular intervals of fortnight/month/quarter as the case may be.

B.  SNP & Nutrition Health Education targeting:

           Target and focus should be especially on the most malnourished children in the Anganwadi.  The Anganwadi Workers and supervisor should work with the families of such children on a sustained continuous basis so that family becomes not only conscious and aware of the problem but also accepts responsibility for the same and brings about changes in the nutritional pattern of the child/family and the way it feeds and looks after its children.  The following specific strategy is suggested:

         i)   Every Anganwadi Worker will select four families having children with worst nutritional status.  Selection of the family should be made on the basis of Nutritional Status of the children strictly in the order of IV th grade, IIIrd grade, IInd grade and Ist grade.  Thus first of all families of Grade IV children will be taken followed by grade-III, grade-II and grade-I.  If there are no grade-IV, Grade-III children, then Grade-II children families will be taken.  If there are no Grade-II then Grade-I children families will be taken.

         ii)  The Anganwadi Worker as part of her normal daily duties is supposed to spend one-hour everyday visiting families.  This time should now be used by her for visiting just two families in a day, amongst the families of four children so selected, spending at least half an hour with each family.  Thus, if there are four families, in one week, there would be at least 3, half hour visits, 12 visits in a month, over a two month period this would mean atleast 25 visits to each family.

Each worker should work with these four families for a period of two months continuously during which period she should:-

a)    Explain to members of the family (Father, mother, grandmother, grandfather, aunts, other adolescents and adults in the family) that the nutritional status of the child is very poor and its adverse consequences on the growth and development of the child if such malnutrition persists.  She should leave a handwritten note about this with the family.

b)   Study the eating habits of the family and point out if members, especially the child/children in question and girl children are getting adequate nutrition and what the family should do to change its nutritional habits.  Ascertain whether SNP given to the child is being given as an additionally or is it substituting normal food intake and further ensure that SNP remains an additionally.  A special note should be kept about whether the family discriminates in giving nutrition for the girl child/adolescent girls/women in the family.  Are there any pregnant women in such families and are they getting sufficient nutrition.

c)   The Supervisor will prepare a nutrition plan for the child which should be explained to the mother and the family and given to the family in writing.  On her visits to the family the Anganwadi Worker must insist that the family follow the nutrition plan and if not she must find out why the family is not following the plan.  This should then be discussed in the Parents Committee and also brought to the notice of the Supervisor for further action.

d)   Mothers/Parents Committee of Parents of all malnourished children should be formed and the case of these four families should be discussed in this Committee at least once a week noting the progress made per week.  These committee meetings should be used for experience sharing. Discrimination in nutrition to girl children, adolescent girls, women and pregnant women, if present should be highlighted and discussed in such meetings.  Supervisors should attend at least one meeting per Anganwadi/per month and Child Development Project Officer should make it a point to attend all those meetings where children are not showing any improvement.

e)    These children should be weighed every week preferably during the visit to the family and the family should be associated in weighing the child.  A copy of the weight record of the child should be given to the family.  The weekly progress of the child should also be discussed with the family.

f)    The Anganwadi Worker could also tie up with the ANM and get her to visit these families during this period at least once in a month.

g)   Anganwadi Workers should ensure that all children including pregnant women in these families have been properly immunized.

h)   After two months the status and progress made in these four families in respect of these four or more children should be explained and highlighted in the Parents committee.

i)    After two months another set of four families should be selected and the process repeated.

j)    In this way, a concentrated 2 months interaction with four families would take place covering 24 families per Anganwadi Centre in a year.  We could thus cover about 3.25 lakh families/children in a year and provide them comprehensive information and knowledge about child care and nutrition, health and hygiene, pre-school education and thus not only improve the status of the malnourished children in the family but also prevent future malnourishment from re-occurring among children born to such families.

:: PLAN  OF  ACTION ::

For Anganwadi Workers:

1. Anganwadi Workers will adopt all IVth, IIIrd, IInd and Ist grade children of 4 families of her AWC for improving the nutritional status of children for two months.  These children should be selected in the order of all IVth & IIIrd  grade children of her area and then the weakest children from IInd grade and if no grade II children are available weakest Grade I children.  She will maintain detailed record in respect of four families and its malnourished children for a period of two months.
   

2. She will explain to members of family (Father, Mother, Grandmother, Grandfather, Aunts, other adults or adolescents in the family) the poor nutritional status of the child/children and the adverse consequences on the growth and development of the child if such malnutrition persists.  She should leave a handwritten note explaining this with the family.
   

3. Study the nutritional/eating habits of the family and point out if members especially the child/children in question and girl children in the family are getting adequate nutrition and suggest what the family should do to change this.Also ascertain whether SNP given to the child is being given as an additionality or is its substituting normal food in take.
          A special note should be kept about whether the family discriminates in giving nutrition/food to the girl child/adolescent girls/women in the family since this could have a long-term impact on the weight of babies born to such women in future.  Are there any pregnant/nursing women in such families and are they getting sufficient nutrition.
   

4. Workers will study the food pattern of these children (what they are eating & how much they are eating) and the same should be reported to the concerned supervisors.  On the basis of this information each concerned supervisor will plan the dietary chart for the family with special focus on the malnourished child/children which will be handed over to the mothers pointing out the deficiency in the present nutrition i.e. diet being given to children and how the deficiency should be made good.  The Anganwadi Worker will ensure that diet plan given to the family is being followed.
   

5. For two months she will visit the four families of these children visiting two families per day spending half an hour with each family to ensure that the child is taking proper diet at home and also ensure that RTE food is consumed by these children only and not shared by the other family members.  If need arises, she may visit these families even after the anganwadi timings.
   

6. She will constitute a parents committee of these malnourished children and will conduct meeting with these committees every week.  During the meeting mothers/parents will be educated about Nutrition and Health Needs of children, malnutrition and its causes, consequences and treatment, hygiene in food prepared and storage, food fad and fallacies, home made weaning foods etc.  Discrimination in nutrition to girls/adolescent girls/women/pregnant women, if noticed should be highlighted and discussed in such meetings.
   

7. She will regularly weigh all such children weekly in addition to weighing all other children at the intervals required (such as all grade-III, grade-IV children in Anganwadi in addition should be weighed every week, grade II children every fortnight and the rest every month).  The weekly Progress of the child will be discussed with the family.  She will also allow these four families to weigh their children and give a copy of the weight record of the child to the family.
   

8. If even after a month, no improvement is observed in the weight of these children then she will find the reasons for it and will report the same to Supervisor for further action.
   

9. Anganwadi worker will ensure that in future weight of every child of her area is taken at birth and record is maintained properly.  Incase, where mother has planned to give birth to the child outside the village, Anganwadi Worker should issue a card to such mother for recording the weight of new born at that place.
   

10. A.W.W. will ensure that the regular health check-ups of these children are done.  She will also go along with the parents of these children during their health check up especially in referred cases to ensure that they are properly seen/attended by health functionaries.

For Supervisor :

• She will maintain a record of all the families children adopted within her jurisdiction.  She will do regular monitoring of weight of the adopted children/families every week.
  

• Fortnightly visit the family (both parents) of these children and discuss about the problems of malnutrition and its solution.
  

• During these 2 months, supervisor will visit IVth, IIIrd grade i.e. severely malnourished children and IInd grade i.e. moderately malnourished children and their families every 15 days.  During the visit she will spend the whole day in the village meeting families of these children and monitoring their weight and diets and educating the mothers/caretakers of these children.
  

• She will conduct meeting with mothers/parents committee of these children twice a month.
  

• She will make diet plan/nutrition plan of these children/families according to their family status, availability of food, taste and preferences etc. and get the same handed over to the parents through the Anganwadi Worker.
  

• She should visit all these four families of village when on tour.
  

• She will report every fortnightly to CDPO about the progress of these children.
  

• She should orient the SHGs/Mahila Mandal/NGO etc. so that they can act as pressure group to sensitize the community about malnutrition.
  

• In case of additional charge the Supervisor will cover 50% of Anganwadi Centre of both the circles allotted to her.

For CDPOs : 

• She will visit the families of all those children which do not show any improvement even after one month and she will take mother/parents committees meeting of such children every month.
  

• She will monitor the progress of children every fortnight and send report of these children to Programme Officer every month.

For Programme Officers:

1. Programme Officer will review report of these children separately and will send the monthly report to headquarter on prescribed format.
   

2. All District Programme Officers will co-ordinate with the Food and Nutrition Board representative and prepare a Block Specific set of recipes which the parents can give to the mal-nourished children of grade IInd, IIIrd and IVth.  The recipes should be developed season-wise i.e. separate for winter season, Monsoon season and summer season depending on the availability of foods.  Keeping in view their eating habits.  For preparation of reciepes Home Science colleges can also be roped in.

AMMENDMENT IN THE NUTRITIONAL STRATEGY:

The following ammendments have been made in January 2004:

1) The duration of adoption of families by Anganwadi Workers has been extended to three months.Ist quarter starting from January to March. IInd quarter from April to June. IIIrd quarter from July to September and IVth quarter from October to December.

2) The target of visit of Anganwadi Workers is reduced to two times per family per week instead of three times per family per week which comes to 32 visit per month instead of 48 visit per month. So now in three months Anganwadi Worker will conduct 96 visit of the adopted families.

3) Child Development Project Officer will visit all the families/children adopted under the strategy in all those Anganwadi Centres which are visited by her during the month in accordance to the targets fixed by the Department. She should visit all the adopted children/families of the block with in three months.

 

ICDS TEAM:


The ICDS team comprises the Anganwadi Helpers/Anganwadi Workers, Supervisors and the Child Development Project Officers.

The Medical Officers (MOs), the Lady Health Visitors and Multipurpose Health Workers (Females) form a team with Women and Child Development Department functionaries to implement ICDS.

The Anganwadi Worker is a community based, frontline voluntary worker of the ICDS programme selected from the community. She is assisted by an Helper in conducting activities. The Supervisor is responsible for 17-25 Anganwadis, depending upon the nature of the project. The Child Development Project Officer is overall in charge at the block level and provides the link between ICDS functionaries and the Government administration.

Committees formed for Supervision, Co-ordination and Monitoring

• Mothers Committee at the Anganwadi Level

• Village Level Co-ordination Committee

• Sub-Divisional level Co-ordination Committee

• District Level Co-ordination Committee

• State Level Co-ordination Committee

             COMMITTEES :

Mothers Committee at the Anganwadi Level

• Village level Co-ordination Committee

• Sub-divisional level Co-ordination Committee

• District Level Co-ordination Committee

• State Level Co-ordination Committee

• Grievence Redressal Committee for Anganwadi workers and Helpers

             To redress the grievances of Anganwadi Worker and Anganwadi Helpers, the grievances redressal committee for Anganwadi Workers and Helpers had been constituted vide letter No. 24467-658/CD-I/WCD/2000, dated 23.10.2000 comprising of the following:-

      1.      Concerned Additional Deputy Commissioner                  Chairperson
      2.      Senior women member of the Zila Parishad                   Member
      3.      Concerned Programme Officer                                    Member Secretary
      4.      All Concerned CDPOs                                                 Members
      5.      One representative of Anganwadi Workers                   Member
               from each block
      6.      One representative of Helpers from each block             Member

               The committee will meet quarterly to solve/dispose of the problems of Anganwadi Workers and Anganwadi Helpers.

           ROLE OF PANCHAYATI RAJ :

A.   In the Selection Committee of Anganwadi Worker, women member at the block       
      level  Samiti to be nominated by the Zila Parishad, has been included. 

B.   The willing women member of Zila Parishad can conduct visit to Anganwadi    
      Centers along with Programme officer once or twice a month. 

C.   In the Selection Committee of Anganwadi Helper, women  Panch /women  
      sarpanch at the Panchayat level has been included. 

D.  Voluntarily presence of women member of block samiti at the time of   
     disbursement of honorarium to Anganwadi Workers & Helpers.

E.   The women member of Panchayat Samiti can conduct visit to Anganwadi Centre
      alongwith Child Development Project officer (CDPO) once or twice a
      month.

F.   Presence of Mahila Panch/Mahila Sarpanch at the time of distribution of 
     Supplementary Nutrition once a week.

G.   The selection of mohalla for setting up of Anganwadi Centre in the village by
      the Panchayat.

H.   Maintenance of Anganwadi building and participation /contribution in the
      Construction of Anganwadi buildings.

I.    Arrangement of electricity, water and cleanliness of Anganwadi Centre.

J.    Every Supervisor will take Mahila Panch/ Mahila Sarpanch to Anganwadi Centre during
       visit.

K.   Monitoring  and review of ICDS scheme at the Panchayat Samiti Level and Zila
      Parishad level.

L.   For bringing transparency in the functioning of the Department, review of  progress of
      other schemes by Panchayat Samiti and Zila Parishad in meetings within  their
      jurisdictions.

            Child Development Project Officer will send progress report and review note to the respective Panchayat Samiti/Zila Parishad every month and Programme Officer will present detailed data including  targets and achievements before the Zila Parishad. The Block Samiti will endorse its observations/remarks to the Programme Officer, if any, on the programmes which will be sent to the Zila Parishad by the Programme Officer by including it in the review note for information and proper management.  After evaluation , the Zila Parishad will send its observation/remarks to the Department for necessary action.

  ICDS EXPANSION:

The ICDS Scheme was sanctioned during 1975-76 in just one block of the state. ICDS scheme had been expanded rapidly in Haryana state both under Central and State sectors. However, the Govt. of India converted 48 state sector ICDS Projects into central sector in the year 1996-97 and thus, all the ICDS projects became centrally sponsored . At present, there are 116 Operational ICDS Projects in Haryana.

                                  Universalisation Of ICDS:

As a step towards universalisation of ICDS, the State Govt. proposes to expand ICDS in uncovered areas to reach the unreached children.The Govt. of India has sanctioned 12 ICDS projects and 2813 Anganwadi centres under this scheme vide their Letter No. 14-10/2005 -CD1 dated 19th August ,2005.The details of sanctioned ICDS projects and Anganwadi Centres are given below: