Ensuring Nutritional Support to Children

by N. C. Joshi, *Assistant Director (M & C), PIB, New Delhi

India is the home to the largest child population in the world. “The development of children is the first priority on the Government’s development agenda, not because they are the most vulnerable, but because they are our supreme assets and also the future human resources of the country”. As per 2001 census, India has around 157.86 million children, constituting 15.42% of India’s Integrated Child Development Services (ICDS) — one of the world’s largest programmes for early childhood development. ICDS is the foremost symbol of India’s commitment to her children. It is India’s response to the challenge of providing pre-school education on one hand and breaking the vicious cycle of malnutrition, morbidity, reduced learning capacity and mortality, on the other.
The scheme has covered many milestones ever since it was launched in October, 1975. Today, it is globally recognized as one of the most unique community based outreach programmes catering to the health and nutrition needs of children under six, their mothers, adolescent girls, pregnant women, nursing mothers and all women who are in the age group of 15-45 years especially from vulnerable and remote areas.

Objectives
An integrated package of services in a convergent manner are provided by the Scheme for the holistic development of the child. Basically it aims at laying the foundation for proper psychological development of the child; improve nutritional & health status of children between 0-6 years; reduce incidence of mortality, morbidity, malnutrition and school dropouts; enhance the capability of the mother and family to look after the health, nutritional and development needs of the child and achieve effective coordination of policy and implementation among various departments to promote child development.

Services
Basic services are rendered through community-based workers and helpers, at a centre called the ‘Anganwadi’. The Anganwadi, literally a courtyard play centre, is a childcare centre, located within the village itself where Supplementary nutrition, Non-formal pre-school education, Immunization, Health Check-up, Referral services are given to children below 6 years, pregnant and lactating mothers, Nutrition and Health Education are for women in the age group of 15-45 years.

Supplementary Nutrition
This includes supplementary feeding and growth monitoring and prophylaxis against Vitamin A deficiency and control of nutritional anemia. All families in the community are surveyed, to identify children below the age of six and pregnant and nursing mothers. They avail of supplementary feeding support for 300 days in a year. By providing supplementary feeding, the Anganwadi attempts to bridge the protein energy gap between the recommended dietary allowance and average dietary intake of children and women.
Growth Monitoring and nutrition surveillance are two important activities that are undertaken. Children below the age of three years of age are weighed once a month and children of 3-6 years of age are weighed every quarter. Weight-for-age growth cards are maintained for all children below six years. This helps to detect growth faltering and helps in assessing nutritional status. Besides, severely malnourished children are given special supplementary feeding and referred to health sub-centres, Primary Health Centres as and when required.
On an average, daily nutritional supplements to the extent of 300 calories and 8-10 grams of protein is given to children below 3 and between 3-6 years. Malnourished children on medical advice after health check-ups are given double the supplement and pregnant and lactating mothers are given 500 calories and 20-25 grams of protein.

Pre-School Education
This component for the three-to six years old children in the Anganwadi is directed towards providing and ensuring a natural, joyful and stimulating environment, with emphasis on necessary inputs for optimal growth and development. The early learning component of the ICDS is a significant input for providing a sound foundation for cumulative lifelong learning and development. It also contributes to the universalization of primary education, by providing to the child the necessary preparation for primary schooling and offering substitute care to younger siblings, thus freeing the older ones – especially girls – to attend school.

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 malnutrition. Immunization of pregnant women against tetanus also reduces maternal and neonatal mortality. This service is delivered by the Ministry of Health and Family Welfare under its Reproductive Child Health (RCH) programme. In addition, the Iron and Vitamin “A” supplementation to children and pregnant women is done under the RCH Programme of the Ministry.
Health Check-ups
This includes health care of children less than six years of age, antenatal care of expectant mothers and postnatal care of nursing mothers. These services are provided by the Auxiliary Nurse Midwife (ANM), Medical Officers incharge of Health Sub-Centres and Primary Health Centres under the RCH programme of the Ministry of Health and Family Welfare. The various health services include regular health check-ups, immunization, management of malnutrition, treatment of diarrhoea, deworming and distribution of simple medicines etc.

Referral Services
During health check-ups and growth monitoring, sick or malnourished children, in need of prompt medical attention, are referred to the Primary Health Centre or its sub-centre. The anganwadi worker has also been oriented to detect disabilities in young children. She enlists all such cases and refers them to the ANM and Medical Officer in charge of the Primary Health Centre/ Sub-centre. Such cases referred by the Anganwadi worker are to be attended to by health functionaries on priority basis.

Nutrition and Health Education
NHE is the key element of the work of the anganwadi worker. It forms part of BCC (Behaviour Change Communication) strategy and has the long term goal of capacity-building of women – especially 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.

Allocation of Funds
ICDS is a Centrally-sponsored Scheme implemented through the State Governments/UT Administrations with 100% financial assistance for inputs other than supplementary nutrition, which the States were to provide out of their own resources. From 2005-06, the Government has decided to share with the States 50 per cent cost of supplementary nutrition. This Central assistance has been proposed to ensure that supplementary nutrition is provided to the beneficiaries for 300 days in a year as per nutritional norms laid down under the Scheme.
Almost three times increase has been made in total allocation for ICDS from Rs. 2178 crore in 2003-2004 to Rs. 7260 crore current financial year.

The Team
The ICDS team comprises of the anganwadi helpers, anganwadi workers, supervisors, Child Development Project Officers (CDPOs) and District Programme Officers (DPOs). Anganwadi Worker, a lady selected from the local community, is a community based frontline voluntary worker of the ICDS Programme. She is also an agent of social change, mobilizing community support for better care of young children, girls and women. Besides, the medical officers, the Lady Health Visitors (LHVs) and Auxillary Nurse Midwife and Female Health Workers from nearby Primary Health Centres (PHCs) and Health Sub-Centre form a team with the ICDS functionaries to achieve convergence of different services.

Incentives to Anganwadi Workers
The Government has introduced ‘Anganwadi Karyakartri Bima Yojana’ to Anganwadi Workers/Anganwadi Helpers from April 1, 2004 under Life Insurance Corporation’s Social Security Scheme.
In order to motivate the Anganwadi Workers and give recognition to good voluntary work, a Scheme of Award for Anganwadi Workers has been introduced, both at the National and State Level. The Award comprises Rs.25,000/- cash and a Citation at Central level and Rs.5000/- cash and a Citation at State level.

Coverage
Currently, services under the scheme are being provided to about 787 lakh beneficiaries, comprising of about 650 lakh children (0-6 years) and about 137 lakh pregnant and lactating mothers through a network of about 10.53 lakh Anganwadi Centres.

Special Focus on North East
Keeping in view the special needs of North Eastern States, the Central Government sanctioned construction of 7600 AWCs in 2004-05. In the wake of expansion of ICDS Scheme in 2005-06, it has been provided in the Scheme itself that Government will support construction of AWCs in NE States. To ensure coverage of all uncovered habitations/settlements, population norms for sanctioning an AWC have been relaxed.

BPL No Longer A Criteria
Contrary to earlier instructions now supplementary nutrition under the Scheme is not confined to beneficiaries of BPL families only. Coverage of ICDS to include SCs/STs/Minority- Instructions have been issued to all the States/UTs to give priority in location of Anganwadi Centres in areas predominantly inhabited by SCs, STs and Minorities
There has been significant progress in the implementation of ICDS Scheme during the last 3 years both, in terms of increase in number of operational projects and Anganwadi Centres (AWCs) and coverage of beneficiaries.
It is significant to note that during a period of about four years i.e. from 31.3.2004 to 31.1.2008, the number of beneficiaries for supplementary nutrition have registered an increased of 97 per cent.

Similarly, the number of children (3-6 years) attending Anganwadi Centres for pre-school education has increased from 204.38 lakh to 326.38 lakh, an increase of 60 per cent during the same period. These data show that ICDS is definitely making in roads to wipe out malnutrition and to ensure over all development of children.

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