Siddharth Agarwal: Fixing ICDS

The Supreme Court directed the government on December 13, 2006 to operationalise a minimum of 1.4 million anganwadi centres (AWCs) required for the universalisation of the Integrated Child Development Services (ICDS) by December 2008. The Court order stressed that rural communities and slum dwellers should be entitled to an "anganwadi on demand" not later than three months from the date of demand in cases where a settlement has at least 40 children under six but no anganwadi. In India, where about 35 per cent of the population is food insecure and 42 per cent of the children are malnourished, ICDS can make a huge difference. The Supreme Court had directed the governments to "universalise" the ICDS in 2001 and then reiterated this in 2004. The progress, however, has been slow. Supplementary nutrition reaches only 40.3 million children of the total 158 million in the zero-six age group, and under 20 per cent of the women who should be covered by the scheme are covered.

The gap between the availability and demand for ICDS centres is more acute among the rapidly growing urban poor. The current 100 million urban poor are estimated to double to 200 million in the next 15 years. The prevalence of malnutrition among the urban poor is enormous, with 57 per cent of under-three-year-old children malnourished. In 2005, there were 360 urban ICDS projects for about 100 million urban poor, which is a coverage of around a third.

This year's budgetary allocation for ICDS shows a three-fold increase vis-a-vis 2004-05. However, there have been delays in the utilisation of the allocated budget owing to procedural delays at all levels and delays in operationalising sanctioned projects. In the 2004-05 financial year, the government sanctioned the opening of 1.88 lakh new AWCs and another 1.07 lakh in the last week of August, 2006. However, these new AWCs have so far not been operationalised. As the data available indicates, till now only 10.5 lakh centres have been sanctioned (including 1.8 and 1.07 lakh new AWCs), which still leaves a deficit of 3.5 lakh centres. "Focus on Children Under Six" (FOCUS), an independent assessment of the programme done by the Right To Food Campaign, highlighted the rampant corruption and fudging of records while implementing the scheme.

Experience has demonstrated that the involvement of local NGOs can be helpful. The NGOs can also link the community with their other programmes such as micro-credit, thereby maximising benefits to people. It would also help if we employ anganwadi workers and helpers from the slums themselves.

Apart from improving the nutritional status of women and children, anganwadi centres also play a crucial role in the delivery of healthcare services. Along with the Auxiliary Nurse Midwife (ANM) and the Accredited Social Health Activist (ASHA), the anganwadi worker is envisaged to play a key role in promoting health awareness and the demand and utilisation of services. The ICDS programme needs to proactively and sensitively focus on mobilising urban poor communities for collective action since social cohesion and support environment is far weaker in these areas as compared to villages.

The need is to focus our attention on the delivery of the public health system to the millions of underprivileged city dwellers who despite being in the neighbourhood of India's growing millionaires, continue to suffer social, nutritional, health and capability deprivation. It is our collective responsibility to make a better place for them to live and contribute to the overall growth of our nation.

The author is Executive Director, Urban Health Resource Centre