INTEGRATED CHILD

DEVELOPMENT SERVICES
(ICDS)

Dr. Sanjeev Gupta;MD

Professor, Department of Community Medicine
LNMC, Bhopal
 Background
• Started in 1975, Managed and run by Ministry of Women and
Child Development/HRD

• Funded by State and Central Government on 50-50 sharing

basis since 2005-06 Government of India

• Modified the cost sharing pattern under ICDS by giving aid of

60 per cent of the financial expenditure to the states/UTs.

• In North-East states and Himalayan states the share is 90:10

and in Union Territories without legislation it is 100% central
share.
 ANGANWADI
 Angan means Courtyard
 Giving the kids and females a homely
environment and providing services which
promote their health at no extra cost
 One Anganwadi Centre caters to a population of
400- 800. More centres can be established if
population increases in multiples of 800.
• 1 AWC for 400-800 population
• 2 AWCs for 800-1600 population
• 3 AWCs for 1600-2400 population
» Thereafter in multiples of 800- 1 AWC.
 Population Norms under ICDS
For Mini AWC
• 150-400- 1 Mini AWC
For Tribal/Riverine/Desert, Hilly and other
difficult areas/ Projects
• 300-800- 1 AWC
• For Mini AWC
• 150-300- 1 AWC
Anganwadi on Demand (AOD)
Where a settlement has at least 40 children
under 6 years of age but no AWC
 OBJECTIVES
 To improve the nutritional and health status of children in the age
group of 0-6 years

 To lay down foundation for proper psychological, physical and

social development of the child

 To reduce mortality and morbidity esp due to malnutrition

among 0-6 years and hence decreasing school drop-outs

 To provide coordination among various departments working for

the promotion of child development

 To enhance capability of the mother and nutritional needs of the

child through proper nutrition and health education
 Three Components
• Functionaries: who are responsible for
providing the services available

• Fit to avail services ...Beneficiaries...People for

whom services are available

• Functions...Services available
 FUNCTIONARY
• Main functionary is Anganwadi Worker (AWW), also one
helper is there and one cook is there.
• AWW is preferably chosen from the community she is
expected to serve
• She undergoes 3 month training or min 30 days training
• In lieu of her services provided she is paid monthly
honorarium of Rs 13,000/- approx.
• Helper also gets the honorarium and cook gets money for
fuel used in cooking & ration is provided by the
government.
Beneficiaries Services
Pregnant Women 1. Health Check up
2. Immunisation against Tetanus
3. Supplementary Nutrition
4. Nutrition and Health Education
Nursing Mothers 1. Health Check up
2. Supplementary Nutrition
3. Nutrition and Health Education
Children <3years 1. Supplementary Nutrition
2. Immunisation
3. Health Check up
4. Referral Services
Children Aged 3-6 years 1. Supplementary Nutrition
2. Immunisation
3. Health Check up
4. Referral Services
5. Non – Formal Preschool Education
Adolescent girls (11-18 years) 1. Supplementary Nutrition
2. Nutrition and Health Education
All women 15-45 years 1. Nutrition and Health Education
 SUPPLEMENTARY NUTRITION
• It is to be provided for 300 days in a year to the
beneficiaries who are assigned to have the benefit
Beneficiary Food specification/ day Financial support Remarks

All Children 6-72 month Calories 500 kcal Rs.8 per child/day Cooked Meal for 3-6
age (6m to 6 yrs) Proteins 12-15 gm year old children

Take home Ration for

Children 6-72 month Calories 800 kcal Rs.12 per < 3 year aged kids and
age (severely Proteins 20-25 gm child/day pregnant and lactating
malnourished) mothers

Pregnant and Nursing Calories 600 kcal Rs.9.5 per eligible

women Proteins 18-20 gm female
 Nutrition and Health Education: Given to all females
of 15-45 years of age esp the pregnant and lactating
ones.
 Immunisation: for all the kids and pregnant women
with help of Multipurpose Health Workers. Records are
maintained and available for any future reference.
 Health Check up:
 Antenatal care and postnatal care
 Registration, Immunisation, IFA supplements
 Care of children under 6 years of age
 Growth monitoring, immunisation, detect malnutrition and
management, Vitamin A and Iron supplements, deworming,
management of diarrhoea, ARI and referral services.
• Non Formal Pre School Education:
– Provided to 3-6 year old children
– Help to develop healthy and socially acceptable
attitude, values and behaviour pattern among
children
– Locally made inexpensive toys and other such
objects are used
– No specific syllabus is there
– Help the child to express himself and adjust with
the group
– Help to give direction to the child's actions by
letting him to show his creativity
 Services to Adolescent Girls
• Using the infrastructure of ICDS project, a new
scheme for adolescent girls ...KISHORI SHAKTI
YOJANA
• Nutrition programme was also started for
adolescent girls .
 KISHORI SHAKTI YOJANA
• 11-18 year old girls are benefitted
• Counselling sessions or peer groups are there to discuss
their problems pertaining to physical, reproductive or
psychological health
• Nutrition education is also imparted
• Literacy and numerical skills are gained
• Girls are also provided some vocational training
• All this , helps them to be better home makers in future
life to support their family
 NUTRITION PROGRAMME
• Started in 2009-10

• Running in some selected villages

• Girls aged 11-15 year and weighing less than 30 kg, girls
aged 15-19 years weighing less than 35 kg are
considered undernourished and benefitted

• These girls are provided with 6kg grain every month to

supplement their dietary intake, hence betterment of
nutritional status
 Organisational Set up
• Till 2022, 13422126 AW centre were running through
AWW.

• 751.03 lakh children and 167.62 lakh mothers

(pregnant and lactating)are getting benefits

• COMMUNITY DEVELOPMENT BLOCK....Administrative

Head Office of one project covering a population of
1,00,000
 THE ICDS TEAM:
 The ICDS team comprises the
 Anganwadi Workers and Anganwadi Helpers
 Supervisors ( ONE for 20-25 AWCs) also called MUKHYASEVIKA
 Child Development Project Officers (CDPOs)- Incharge for 4
Mukhya sevikas and 100 AWCs
 Along with: (people from Health and Family Welfare dept.)
 District Programme Officers (DPOs)
 Medical officers
 Auxiliary Nurse Midwife (ANM)
 Accredited Social Health Activist (ASHA) form a team with the
ICDS functionaries to achieve convergence of different
services
 THE ICDS TEAM ( District)
The ICDS team comprises the

• Anganwadi Workers(AWW)

• Anganwadi Helpers (Sahayika)

• Supervisors(LS)

• Child Development Project Officers (CDPOs)

• District Programme Officers (DPOs).

 Anganwadi Worker:

❖AWW maintains the growth chart of every

child and weighs each child under the age of 3
years each month.
❖Children over the age of 3 years are assessed
with an upper mid-arm circumference
(MUAC).
❖She organizes non-formal education for children
of 3-6 years age group.
 AWW
• She teaches mothers on health and nutrition.

• She coordinates with PHC staff for the health

checkup, immunization and referral of

suffering children.

• She provides treatment of minor illnesses.

• She carries out a quick sample survey of the

area and families to find out the total

beneficiaries.
• She maintains all files and records of services

provided and growth of the children and

submit the report every month to Mukhya

Sevika.

• She organizes supplementary nutrition

feeding for children (0-6 years) and expectant

and lactating mothers by planning a menu

based on locally available foods.

Lady Supervisor/ Mukhya Sewika (MS)
• She is a full time worker who supervises the
work of 20, 25 and 17 anganwadi workers in
urban, rural and tribal projects respectively.

• She visits each anganwadi at least once a month,

and coordinates with lady health visitor in
nutritional and health activities.
Child Development Project Officer (CDPO)
• For one project there is one CDPO who covers

one community development block having a

population of 80,000 to 120,000.

• S(h)e supervises, coordinates and guides the

work of entire ICDS project as an in-charge

and supervises 4-5 Mukhya Sevikas.

• He/she is assisted by one assistant CDPO.

 Role of health department

a) Health checkup

b) Handling the referrals from Anganwadi,

c) Immunization is carried out by health workers

female,
d) Health and nutritional education,

e) Continuing education of ICDS staff, and

f) Monitoring of the health component of ICDS.

 INTERNATIONAL PARTNERS
Government of India partners with the following
international agencies to supplement
interventions under the ICDS:
• United Nations International Children’
Emergency Fund (UNICEF)
• Cooperative for Assistance and Relief
Everywhere (CARE)
• World Food Programme (WFP)
 INDICATORS OF MCH CARE
• MATERNAL MORTALITY RATIO (Rate)
• MORTALITY IN INFANCY AND CHILDHOOD
– Perinatal mortality rate
– Neonatal mortality rate
– Post- neonatal mortality rate
– Infant mortality rate
– 1-4 year mortality rate
– Under five mortality rate
– Child survival rate
 MATERNAL MORTALITY RATIO
• Death of a woman who is pregnant or
within 42 days of termination of pregnancy,
irrespective of the site or duration of
pregnancy, from any cause related to or
aggravated by the pregnancy or its
management
Total no. Of female deaths due to complications of
pregnancy, childbirth or within 42 days of delivery from
• It is expressed
puerperal as:
causes in an area during a given year
X 1000 (or 100,000)
Total no. Of live births in the same area and year
• The appropriate denominator for the maternal mortality
ratio would be the total number of pregnancies (live births,
fetal deaths or stillbirths, induced and spontaneous
abortions, ectopic and molar pregnancies).

• However, this figure is seldom available and thus number

of live births is used as the denominator.

• In countries where maternal mortality is high denominator

used is per 1000 live births but as this indicator is reduced
in numbers with better services, the denominator used is
per 1,00,000 live births to avoid figure in decimals.
 Other terms:
• Late maternal death
Late maternal is death of a woman from direct or indirect
obstetric causes, more than 42 days but less than one year, after
termination of pregnancy.

• Pregnancy related death

defined as : the death of a woman while pregnant or within 42
days of termination of pregnancy, irrespective of the cause of
death.
• Direct obstetric deaths
The deaths resulting from obstetric complications of the
pregnant state, from interventions, omissions, or
incorrect treatment, or from a chain of events resulting
from any of the above are called direct obstetric deaths.

• Indirect obstetric deaths

Those resulting from previous existing disease or disease
that developed during pregnancy and that was not due
to direct obstetric causes but was aggravated by the
physiological effects of pregnancy.
 Statistical measures of maternal mortality
 Maternal Mortality Ratio: (MMR) Number of maternal
deaths during a given time period per 1000 (or 100,000) live births
during the same period.
 Maternal mortality Rate: Number of maternal deaths
during a given time period per 1000 (or 100,000) women of
reproductive age during the same period.
 Adult lifetime risk of maternal death: Probability of
dying from a maternal cause during a woman’s reproductive life
span.
 Proportional maternal deaths of women of
reproductive age : Number of maternal deaths in a given time
period divided by the total deaths among women aged 15-49 years.
 Sources of data providing information
about Maternal Mortality

• Civil Registration Systems: Birth and Death

Registration
• Sample Registration System
• Household Surveys
• Reproductive age mortality studies
• Verbal autopsy to know the cause of death
among women
• Census
 RHIME
 Representative, re-sampled, routine, Household
Interview of Mortality with Medical Evaluation
 Started in year 2000
 Modification of SRS
 Conducted by independent team
 Enhanced form of Verbal Autopsy
 Cause of maternal death is tried to be established
and classified as ICD-10 coding
 Helps to compare the status on a global level in
terms of nos. And the underlying causes
 MMR in India and states
India and States MMR /100,000 live births Lifetime risk

India 97 0.4%
Haryana 110 0.4
Punjab 105 0.3
Kerala 19 0.01
Tamil Nadu 90 0.2
Gujarat 122 0.3
Maharashtra 33 0.2
UP 167 1.0
Bihar 118 0.8
Rajasthan 113 0.9
Assam 195 0.8
 Causes of Maternal Mortality
• Direct causes- 80%
• Indirect Causes- 20% (include anaemia,
malaria, heart diseases etc.)
Causes of maternal mortality in India
Causes

34 Hemorrhage
38 Sepsis
Hypertensive disorders
Obstructed labour
Abortions
Other Conditions

8 11
5 5
 Determinants of Maternal Mortality
Medical Causes Social Factors
Obstetric Causes Age at child birth
Hemorrhage Parity
Infection Too close pregnancies
Toxemia of Pregnancy Family Size
Obstructed Labour Malnutrition
Unsafe Abortion Poverty
Non- Obstetric causes Illiteracy
Anemia Gender preference
Associated systemic diseases like cardiac, Women- weaker sex- often neglected and
renal, hepatic, metabolic etc. prone to domestic violence
Malignancy Poor Sanitation
Accidents Lack and underutilisation of MCH sevices
Delivery by untrained dais
Delay in availing expert services
 Reasons for DELAY
• Delay in identifying the danger signs
• Delay in seeking care
• Delay in transport to appropriate health facility
• Delay in provision of adequate care

ASHA worker and other local leaders and social

groups can help a lot in decreasing the time lag
during these events to a great extent.
 Indicators for maternal health care services
utilisation and current status
INDICATORS NFHS-V (2019-2021)
1.
Antenatal Care
a.
Any Visit 77.0%
b.
4 visits 58.1%
2.
Deliveries
a.
Institutional 88.6%
b.
Safe Delivery 89.4%
3.
IFA tablets for 100 days 44.1%
4.
Postnatal Check up within 2 days 79.1%
 Preventive and Social Measures
 Early registration of pregnancy
 Atleast 4 ANC visits
 Dietary supplementation esp anamia
 Prevent infection
 Prevent hemorrhage
 Prevent and timely management of complications
 Treating medical problems
 Tetanus prophyllaxis
 Safe delivery: Three cleans and trained birth attendants
 Institutional delivery esp in high risk cases
 Promote family planning
 Safe abortion
 Involve local leaders and NGOs for social support in terms of
women literacy, no gender bias, women epowerment.
Thank you