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Towards a new dawn

Practices
The ICDS Experience

Government of India
MINISTRY OF WOMEN AND CHILD DEVELOPMENT
Child Development Bureau
And
NATIONAL INSTITUTE OF PUBLIC COOPERATION
AND CHILD DEVELOPMENT
Potential Good Practices
The ICDS Experience

Government of India
Ministry of Women and Child Development
Child Development Bureau
and
National Institute of Public Cooperation
and Child Development
Printed by National Institute of Public Cooperation and Child Development
on behalf of Ministry of Women and Child Development
Year of Publication: April 2013
No. Copies – 500
 POTENTIAL GOOD PRACTICES – THE ICDS EXPERIENCE

This document is an endeavour of the Ministry of

Women and Child Development, Government of India
to highlight the effective initiatives taken by the states
and union territories for implementation of ICDS

This document is a compilation of information gathered

both from secondary sources and those shared by
States and Union Territories

iii
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Towards a new dawn MINISTER OF STATE (INDEPENDENT CHARGE)
d`".kk rhjFk MINISTRY OF WOMEN & CHILD DEVELOPMENT
GOVERNMENT OF INDIA
Krishna Tirath NEW DELHI-110001

MESSAGE
I am pleased to share the document on “Potential Good Practices – the ICDS Experience”,
a compilation of successful pilots, integrates projects which have been pioneered through
ICDS showcasing practices that played a significant role in improving delivery of services
under ICDS which currently operates through more than 13.18 lakh Anganwadi centres, each
manned by an anganwadi worker who provides an integrated package of health, nutrition
and early childhood education services targeted to children aged below six years; pregnant
and nursing mothers; and adolescents girls.

It is widely recognised that ICDS is a well designed programme having a wide outreach,
bottlenecks in service delivery hamper harnessing full potential of the programme. Considering
the fact that better service delivery is a pre-requisite for inclusive growth, variations in
implementation of specific components of ICDS, as a response to local needs, are being
adopted in States and some of the initiatives have been found to be more effective than the
prescribed guidelines.

The document Potential Good Practises clearly demonstrates the fact that participants of
people and community ownership of the programme is essential for success of any
programme. Also an important point which stems out is that best practices in this document
are not only from states that fare well on development indicators but also from states that are
lagging behind highlighting the fact that all states irrespective of their positions vis-a-vis human
development indices, are striving to implement programmes innovatively in order to make a
dent on improving maternal and child health and nutrition.

The Ministry of Women and Child Development, Government of India has also reviewed the
practices articulated by the States and agencies during different interactive sessions with a
purpose to look at best context-specific options for up scaling and replication in other States,
where conditions are appropriate. In this direction, an attempt has been made through this
document, to identify and illustratively describe activity-linked processes in some of the
potentially good practices and processes.

I appreciate the efforts put in by officials of MWCD and NIPCCD in bringing out the document
and hope that this document by the Ministry of Women and Child Development will be a
useful resource for administrators, programme manages, implementers, ICDS officials and
policy makers in providing direction for innovations that impact the well-being of our children
and women.

(Krishna Tirath)
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GOVERNMENT OF INDIA
u, lekt dh vksj MINISTRY OF WOMEN & CHILD DEVELOPMENT
Towards a new dawn
DR. SHREERANJAN, IAS SHASTRI BHAWAN, NEW DELHI-110001
Joint Secretary Website : http://www.wcd.nic.in
Tel.: 2338 7683
Fax : 2307 0479
E-mail: [email protected]

FOREWORD

ICDS programme over the years has been explored for innovations, pilots and various models.
Most of these initiatives are unique in nature and have helped ICDS achieve its objectives of
holistic development of the child and contribute significantly to reduction in mortality, morbidity
and malnutrition. The integrated but flexible nature of the programme coupled with inherent
convergence with health and other sectors make it a suitable platform of convergence and
the first outpost for human developments efforts at the habitation level.

I appreciate the efforts of the States Union Territories and Development Partners who have
recognised the importance of the ICDS programme and are continuously striving to improve
its management, delivery mechanisms to address gaps in its implementation. These numerous
endeavours have not been documented and disseminated sufficiently.

This document on “Potential Good Practices – The ICDS Experience” has been
assimilated with the goal of documenting some of the good practices, analyzing them in
detail and providing motivation for replication. It tries to capture a range of pilots and
interventions all of which may not be existent today, but have generated ample lessons,
demonstrated potential or achieved verifiable results.

I understand while each practice is unique and combinations of it can be applied in child
development programmes, there is no single or combined best ways to improve programme
approach in a country with large diversity. Each region needs to define and implement the
most appropriate strategy based on specific needs of community.

Documentation, more so of processes and good practices needs to be internalized and

made systemic in ICDS, this handbook is one such step and I hope many more would come.
I would request States and Union Territories to take initiative and create repositories of good
practices, upload on website and use them for cross learning within and with larger community
of child development.

Several persons have provided technical support in reviewing, selection and documentation
of different good practices. I extend my earnest thanks to all those who gave contributed in
making this publication a reality.

I sincerely hope that this document would serve as an info-pack and compendium of potential
good practices and will benefit programme managers, implementers, ICDS officials and
policy makers in providing direction for scaling up good practices and innovate further.

(Dr. Shreeranjan)
 ACKNOWLEDGEMENTS
Dr. Dinesh Paul
MBBS, MD, MNAMS
Director, NIPCCD

The Report, Potential Good Practices - the ICDS Experience is a

compilation of best practices, successful pilot projects and integrated
projects on child care and growth & development in different states across
India being pioneered under Integrated Child Development Services
(ICDS) scheme. The document is a joint effort of the Ministry of Women and Child Development
and the National Institute of Public Cooperation and Child Development (NIPCCD). It is believed
that the successes achieved in different regions shall be quite valuable for others to be
considered for replication in their settings.

I extend my gratitude and sincere thanks to the members of the Committee constituted by
Ministry of Women and Child Development (MWCD), under the Chairmanship of Director
NIPCCD along with Dr. Arun Gupta of Breastfeeding Promotion Network of India (BPNI) and
Ms.Deepika Srivastava in Planning Commission fortheir inputs and valuable suggestions to
improvise the report .

I extend my gratitude to Women and Child Development Departments of all the State
Governments for providing valuable information on innovative practices being experimented
in their respective states.

I appreciate the efforts put in by Ms Farheen Khurshid, Consultant (MWCD) and Dr.
Neelam Bhatia, Dr.D.D.Pandey & Dr. Rita Patnaik from NIPCCD who have put immense
efforts in bringing out the document.

(Dinesh Paul)
 Contents

List of Abbreviations .................................................................................................. xiii

List of Tables .............................................................................................................. xix

Introduction ................................................................................................................ xxi

1. SYSTEMS QUALITY IMPROVEMENT ................................................................... 3

1.1 Adoption of New WHO Child Growth Standards ............................................ 3

1.2 Adoption of Joint Mother and Child Protection Card ...................................... 5

1.3 Revised Management Information System (MIS) in ICDS .............................. 9

2. PRACTICES FOR STRENGTHENING SERVICE DELIVERY ............................ 15

2.1. Good Practices in Early Childhood Education ............................................. 16

2.2. Initiatives for Improving Management of Supplementary Nutrition ................ 19

2.3. Nutrition, Health Education and Counselling ................................................ 22

2.4. Convergent Models for Improving Health Services through ICDS ................ 24

3. PRACTICES FOR IMPROVED PROGRAMME MANAGEMENT ........................ 33

3.1 Community Mobilisation .............................................................................. 33

3.2 Use of Monitoring Tools ............................................................................... 34

3.3 Community Participation and Monitoring ..................................................... 34

3.4 Incremental Learning and Supervision ......................................................... 35

3.5 Behavioural Change Communication .......................................................... 36

3.6 Convergence ............................................................................................... 36

3.7 Programme Monitoring and Management Information System .................... 36

3.8 Transparency and Accountability in ICDS .................................................... 38

3.9 Initiatives in Financial Management ............................................................. 38

4. SNAPSHOT OF SOME OUTSTANDING PRACTICES ....................................... 43

4.1 Construction of Anganwadi Centre, PPP Model, Tamil Nadu and Gujarat .... 43

4.2 Strengthening AWC Monitoring, Karnataka .................................................. 43

 4.3 Increasing Reach and Coverage in Gujarat and Haryana............................. 44

4.4 Anganwadi Entry Festival / Campaign in Kerala and Gujarat ....................... 44

4.5 Kuposhan Mukti Abhiyan, Chhattisgarh ........................................................ 44

4.6 Joint Cooking Arrangement “Sanjha Chulha”, Madhya Pradesh................... 45

4.7 Geographical Monitoring and Information System (GMIS),

Andhra Pradesh .......................................................................................... 45

4.8 Use of ICT for Daily Monitoring of Supplementary Nutrition,

Madhya Pradesh ......................................................................................... 45

4.9 The Rajmata Jijau Mother-Child Health & Nutrition Mission, Maharashtra .... 46

4.10 Success Story of Lalitpur, Uttar Pradesh ...................................................... 47

4.11 Multisectoral Approach in VHND, Tripura ..................................................... 48

4.12 Nutrition-cum-Day Care Centres (NDCC), Andhra Pradesh ........................ 49

4.13 Balintadarshanam, Andhra Pradesh ............................................................ 50

4.14 Gas Chullah Connections, Gujarat ............................................................... 51

5. INTEGRATED APPROACHES IN EARLY CHILDHOOD CARE ......................... 55

5.1 The Innovative Approaches .......................................................................... 55

5.2 . Lessons Learnt from Integrated Packages ................................................ 69

Annex A .................................................................................................................... 71

Annex B .................................................................................................................... 81

REFERENCES............................................................................................................. 85
 List of Abbreviations

Addl. CMO Additional Chief Medical Officer

AIR All India Radio

ANC Antenatal Care

ANM Auxiliary Nurse Midwife

ARI Acute Respiratory Tract Infection

ASAT Anchal Se AnganTak

ASHA Accredited Social Health Activist

AWC Anganwadi Centre

AWH Anganwadi Helper

AWW Anganwadi Worker

BCC Behaviour Change Communication

BLRM Block Level Resource Mapping

BRT Block Resource Team

BPL Below Poverty Line

BSPM Bal Swasthya Poshan Mah

BSPKs Bal Shikshan Prasar Karyakartas

CB Capacity Building

CBMS Community-Based Monitoring System

CBO Community-Based Organisation

CDPO Child Development Project Officer

CHC Community Health Centre

CHW Community Health Worker

CIG Common Interest Group

CNC Community Nutrition Centre

CNS Community Nutrition Supervisor

CNW Community Nutrition Worker

CPCRI Central Plantation Crops Research Institute (CPCRI)

CLR Centre for Learning Resource

CSB Corn Soya Blend

DIET District Institute of Education and Training

DMMTT District Mobile Monitoring Training Team

DPMU District Programme Management Unit

DST District Support Team

DWCD Department of Women and Child Development

ECD Early Childhood Centre

ECE Early Childhood Education

EGS Employment Guarantee Scheme

FGD Focus Group Discussion

FNHD Fixed Nutrition and Health Days

GIS Geographic Information Systems

GMP Growth Monitoring and Promotion

GMIS Geographical Management Information System

GSS Gram Sampark Samooh

HMIS Health Management Information System

HMRI Health Management and Research Institute

IAY Indira Awaas Yojana

ICDS Integrated Child Development Services Scheme

ICMR Indian Council of Medical Research

IEC Information Education Communication

IECD Integrated Early Child Development

IFA Iron-Folic Acid

INHP Integrated Nutrition and Health Project

IPC Interpersonal Communication

LHV Lady Health Visitor

LRG Local Resource Group

LRP Local Resource Person

MCH Mother and Child Health

MCPC Mother and Child Protection Card

MCHN Mother and Child Health and Nutrition

MDM Mid-Day Meal

MGNREGA The Mahatma Gandhi National Rural Employment

Guarantee Act

MHU Mobile Health Units

MIS Management Information System

MO Medical Officer

MOHFW Ministry of Health and Family Welfare

MPR Monthly Progress Report

MSG Mothers Support Group

NCCS Nutrition Counselling and Care Session

NCERT National Council of Educational Research and Training

NCHS National Centre for Health Statistics

NDCC Nutrition-cum-Day Care Centre

NGO Non-Governmental Organisation

NHD Nutrition and Health Day

NHE Nutrition and Health Education

NIPCCD National Institute of Public Cooperation and Child Development

NHED Nutrition and Health Education Day

NMP Noon Meal Programme

NRC Nutrition Rehabilitation Centre

NRHM National Rural Health Mission

NRHS National Rural Health System

NSS Nutrition Surveillance System

NTT Nursery Teachers Training

ORS Oral Rehydration Solution

P&L Pregnant & Lactating

PD Positive Deviance

PDI Positive Deviant Inquiry

PDS Public Distribution System

PHC Primary Health Centre

PNC Post Natal Care

PPP Public Private Partnership

PRI Panchayati Raj Institution

RCH Reproductive and Child Health

RVO Refined Vegetable Oil

SIERT State Institute of Educational Research and Training

SHG Self-Help Group

SOE Statement of Expenditure

SNP Supplementary Nutrition Programme

SPMU State Programme Management Unit

SSA Sarva Shiksha Abhiyan

TB Tuberculosis

THR Take Home Ration

TINP Tamil Nadu Integrated Nutrition Project

UNICEF United Nations International Children’s Emergency Fund

UT Union Territory

VCD Village Contact Drive

V-CDC Village Community Development Centre

VHND Village Health and Nutrition Day

VHSNC Village Health Sanitation and Nutrition Committee

VO Village Organisation

WAZ Weight for Age Z –Score

WHO World Health Organisation

WHZ Weight for Height Z –Score

WWG Women Working Groups

 List of Tables

Table 1: Initiatives to strengthen Preschool Education in some states

Table 2: Supplementary Nutrition: Supply and Procurement

Table 3: Event-based Initiatives

Table 4: Campaign Mode Initiatives

Table 5: Key Programme Inputs - The Dular Strategy

Table 6: Key Programme Inputs- Positive Deviance Approach

Table 7: Key Programme Inputs- Anchal Se AnganTak (ASAT)

Table 8: Key Programme Inputs- Integrated Nutrition and Health Programme (INHP)

Table 9: Key Programme Inputs-TINP (Phase I & Phase II)

Introduction
 POTENTIAL GOOD PRACTICES – THE ICDS EXPERIENCE

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 POTENTIAL GOOD PRACTICES – THE ICDS EXPERIENCE

Introduction

The Integrated Child Development Services (ICDS) provides an integrated approach for
converging six basic services for improved childcare, early stimulation and learning, health
and nutrition, education, primarily targeting young children (0-6 years), expectant and nursing
mothers.

The Anganwadi Centre is the operational unit of ICDS at habitation level which is also used
for other related schemes like SABLA, IGMSY and RCH which benefit pregnant women,
children and adolescent girls. ICDS has been the seat of several good practices over the
past two decades and the States and Union Territories continue to add newer endeavours
each year.

The Ministry of Women and Child Development acknowledges the efforts of the States, Union
Territories and the collaborative effort of Development Partners in this connection. The Ministry
has put together a compilation of successful pilot projects, integrated projects which have
been pioneered through ICDS. A desk review of website publications, evaluation reports,
process documentation, briefing papers, Annual Programme Implementation Plans (APIP)
and evidence reviews have helped to shortlist a set of good practices in ICDS. The Ministry
has also considered the practices articulated by the States during different interactive sessions.

The selection of these practices was based on certain criteria a) effective service delivery
b) successful bridging of systemic gaps and quality improvement c) community participation
and mobilisation d) convergence e) sustainability and scalability f) impact etc.

The document has been organised in five distinct sections.

System Quality Improvement, which specifically mentions the endeavours which have
brought about a major ‘shift’ in ICDS, and has led to systemic improvement and implementation
with quality.

Strengthening Delivery of the Services under ICDS: Emphasises on State-specific

mechanisms of service delivery which have been implemented for some time and are found
to be effective. It also reflects on the importance of ICDS in delivery of health services like
immunisation, micronutrient supplementation health check-up referral, and management of
undernourished children and captures several convergent models including innovations in
village health and nutrition days.

Programme Management focuses on practices for bridging pertinent systemic gaps and
issues of ICDS such as lack of community engagement and mobilisation, weak monitoring
systems, low capacity etc. Some key areas discussed in the section include involvement of

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 POTENTIAL GOOD PRACTICES – THE ICDS EXPERIENCE

SHGs, mothers’ committee in provisioning of supplementary nutrition, monitoring of Anganwadi

centre, use of monitoring tools, tracking of malnourished children and mobilisation for improved
utilisation of services. It also covers important components like Management Information
System (MIS), web-enabled systems, GIS mapping and name-based tracking of malnourished
children, social audits and efforts for improving financial management in ICDS.

Snap Shot lists some outstanding innovations and good practices by States, which serves
as learning for others.

Assisted Integrated Approaches: This section acknowledges the support and technical
assistance of Development Partners like UNICEF, CARE, World Bank in piloting innovative
community-based approaches through ICDS. Most of these approaches were piloted during
the year 2000-08. These may not be existent today but they have provided ICDS with improved
outcomes in child development, malnutrition reduction, and decrease in morbidity. All these
integrated projects are supported by evidence reviews and evaluations. The compilation
tends to do a comparative study of both the processes and impact of these packages.

Documentation of several good practices and innovations are confined to the state of origin
and are often not available for wider learning.

This compilation is a humble attempt of the Ministry to identify and illustratively describe
activity-linked processes in some of the potential good practices in ICDS. It aims to facilitate
cross learning and exchange of ideas and views for better understanding and replication of
these practices.

xxiv
 SECTION - A

Systems Quality
Improvement
 POTENTIAL GOOD PRACTICES – THE ICDS EXPERIENCE

1 Systems Quality Improvement

The commitments for ICDS in the Eleventh Five-Year Plan emphasised on systems quality
improvement, system strengthening, greater convergence with NRHM and universalisation
with quality.

The Ministry of Women and Child Development took forward the Plan commitments and
several initiatives were taken up to bring about systemic improvement and convergence with
other sectors specially NRHM.

In this connection two noteworthy examples can be cited namely the adoption of New WHO
Child Growth Standards and subsequent introduction of the joint Mother and Child Protection
Card.

Another initiative of the Ministry in this direction is to improve the ICDS reporting mechanism.
The Management Information System (MIS) for ICDS has also been revised for better
assessment, analysis and planning.

These initiatives of the Ministry bring out the clear intent on child-centric approach which
takes into consideration the health, nutrition, cognitive, emotional and social needs of the
child.

It is envisaged that these efforts of systems quality improvement will help to focus on every
child and strengthen linkages with Health in order to achieve the objective of reducing mortality,
morbidity and malnutrition in women and children.

The section elaborates on these major “shifts” in ICDS, for systems quality improvement
which was initiated in the Eleventh plan period and the results will be visible during the Twelfth
plan period.

1.1 Adoption of New WHO Child Growth Standards

In ICDS growth monitoring is an important activity and earlier Harvard Standards were used
specifying Normal, Grade I/II/ III and IV (Mild, moderate, severe and very severe underweight).
These standards were based on growth patterns of formula-fed children. It was felt that a
standard which recognises the breastfed infant as the normative model would be the preferred
choice in India.

The New WHO Child Growth Standards were adopted in India by Ministry of Women and
Child Development and Ministry of Health & Family Welfare. The new standards are based

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 POTENTIAL GOOD PRACTICES – THE ICDS EXPERIENCE

on growth patterns of healthy breastfed children and provide different and new classifications
with options for analysing, updating and harmonising the use of child growth standards. It
demonstrates that children born in different regions of the world, when given an optimum start
in life, have the potential to grow and develop within the same range of height and weight for
age.

A joint policy directive was issued on 6 August 2008, for use of the standards across the
country for monitoring and promotion of young child growth and development within the
Integrated Child Development Services and National Rural Health Mission.

As per the new directive in all Anganwadi centres, nutritional status of the child is being
assessed against Weight- for -Age using individual growth charts separate for girls and boys.
The new growth standards will enable parents, communities and child care providers can
assess early faltering of growth and take timely corrective actions.

As many as 6,666 projects and 12,71,889 AWCs are implementing the new WHO standards
across the country. Intensive training and orientation on the New WHO Child Growth Standards
is continually being imparted through NIPCCD to functionaries of ICDS. A manual of the New
WHO Child Growth Standards has also been developed by NIPCCD.

New growth standards in use at ANC

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 POTENTIAL GOOD PRACTICES – THE ICDS EXPERIENCE

1.2 Adoption of Joint Mother and Child Protection Card

Subsequent to the introduction of the New WHO Child Growth Standards, Mother and Child
Protection Card was introduced jointly by Ministry of Women and Child Development and
Ministry of Health & Family Welfare in March 2010 to be used nationwide in both ICDS and
NRHM.

The Mother and Child Protection Card (MCPC) provides information on comprehensive
package of services addressing the needs of pregnant women and children up to 3 years of
age. It is a simple tool to track maternal and child health and ensuring optimal delivery of
services to both.

The card integrates health, nutrition and development along a life cycle continuum, pictorial
representations, support easy understanding of positive care practices and developmental
milestones. Sections on antenatal and postnatal care capture critical maternal health
parameters. According to the New WHO Child Growth Standards separate individual growth
charts for boys and girls have been incorporated in the card for assessing the nutritional
status of children.

The card has the potential to empower families and communities, encourage demand of
services by raising awareness on child care practices and monitor the individual status of
maternal, child health, growth and development. It is perceived as best practice and means
of functional convergence between ICDS and NRHM.

The card helps ANMs, AWWs and ASHAs for tracking of each child right from conception till
age three; it is also used as an entitlement card for several schemes such as Indira Gandhi
Matritva Sahyog Yojana, Home-based new-born care and Janani Suraksha Yojana.

The card also portrays the utilisation of services from ICDS and NHRM and its use is linked to
critical contact points such as VHND, home visit, post-partum new born care and birth
registration. It also serves as a tool for detecting developmental delays and provides care for
development. A strong means of verification, the card is well aligned to the revised ICDS MIS.

The card is currently being rolled out in the States/ UTs and training of frontline workers in its
use is in progress. A comprehensive guidebook has also been developed by NIPCCD which
serves as an invaluable training manual for using the card, as well as a ready reckoner for
filling the information on health and nutrition indicators by Anganwadi workers, ANMs, ASHAs
and other programme implementers.

As many as under 6,621 projects ,10,12,153 AWCs are making use of the card.

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 POTENTIAL GOOD PRACTICES – THE ICDS EXPERIENCE

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POTENTIAL GOOD PRACTICES – THE ICDS EXPERIENCE

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 POTENTIAL GOOD PRACTICES – THE ICDS EXPERIENCE

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 POTENTIAL GOOD PRACTICES – THE ICDS EXPERIENCE

1.3 Revised Management Information System (MIS) in ICDS

The Management Information System in ICDS has been a standardised data collection
procedure implemented uniformly across all States/UTs. The process relies on manual
entries and compilations. All primary data relating to service delivery are recorded by the
AWWs in prescribed registers. Every month, AWWs compile this information and collate
it into a standardised Monthly Progress Report (MPR) that contains a number of input,
process and impact indicators. These MPRs are then sent to the Supervisors (each of
whom supervises about 25-30 AWCs) who consolidate the reports and forward these to
the Child Development Project Officers (CDPOs), who in turn assemble the reports by
project/block and remit them to the State HQs. At the central level, some of the key indicators
are analysed and Quarterly Progress Reports (QPRs) are prepared and detailed feedbacks
are sent to State government. These key indicators include information on ICDS personnel,
operationalisation of projects and AWCs, beneficiaries of supplemental nutrition and pre-
school education, number of births and deaths, nutritional status etc.

At the State level, programme monitoring data captured through AWC MPRs/Half-yearly
Progress Reports (HPR) are compiled for all the operational projects using the CDPOs’
Monthly Progress Reports (MPRs). Additionally, the State Reports include information on
field visits to AWCs by ICDS functionaries, VHNDs, health-check-ups, immunisation, home
visits by AWWs, etc.

As part of strengthening and systems quality improvement, the Ministry had initiated
revamping of the MIS with an aim to ensure consistent and accurate recording and reporting
of the critical programme data. This was also done to minimise drudgery and reduce time
spent by functionaries in data compilation and allow more time for programme activities
like home visits and counselling of mothers.

Through a long consultative process with the States and other stakeholders, and after pilot
testing in six States, all primary records and registers that are maintained at the AWCs
have been revised / rationalised. On 28 March 2012, the Ministry introduced the revised
MIS and issued detailed guidelines for roll-out of the 11 newly designed colour-coded
registers along with Report formats viz., monthly progress reports (MPRs) and annual
status reports (ASRs).

9
 POTENTIAL GOOD PRACTICES – THE ICDS EXPERIENCE

Glimpses of some of the sample registers produced by MWCD

10
 POTENTIAL GOOD PRACTICES – THE ICDS EXPERIENCE

To ensure uniformity and standardisation in design across the States, the Ministry, for the first
time, undertook centralised designing of these basic MIS formats in all major languages and
produced print-ready versions for release to the States for printing. Print-ready formats in
local languages have been released to all 35 States/UTs. The Ministry has also prepared
detailed roll-out plan including (i) guidelines for induction training on revised MIS for the ICDS
functionaries, (ii) User’s Manual for use by the AWWs and their Supervisors, and (iii) Training
Facilitator’s Manual to be used for imparting induction training of ICDS functionaries at different
levels, particularly for the training of AWWs at the sector level. These manuals are currently
being translated in local languages by the respective States.

Concurrently, the Ministry is also working with the National Informatics Centre (NIC) for
developing a web-enabled MIS which will help capturing basic programme monitoring
data entry from the Anganwadi/project level as well as help compilation and generation of
progress reports at different levels. This will help in collecting and providing data on a real
time basis to support timely programmatic actions and interventions. A new web-portal
(www.wcd.nic.in/icds) has been created for enabling the MIS data entry by the States/UTs.

11
 SECTION - B

PRACTICES FOR
STRENGTHENING
SERVICE DELIVERY
 POTENTIAL GOOD PRACTICES – THE ICDS EXPERIENCE

2 Improving Service Delivery in ICDS

The ICDS programme is a major flagship programme of Government of India which reaches
out to all habitations in the country. It currently operates through more than 13, 00,000 Anganwadi
Centres, each manned by an Anganwadi Worker and an anganwadi helper. It provides an
integrated package of health, nutrition and early childhood education services targeted at
children aged below six years; pregnant and nursing mothers; and adolescent girls. Nutritional
and health education services are also provided, in general, for all women in the age group
15 to 45 years. The programme is universal, and reaches out to women and children with low
socio-economic status as primary beneficiaries. Specific services provided through the
programme include:

– Immunisation

– Health Check-up

– Referral Services

– Nutrition and Health Education

– Supplementary Nutrition

– Early Childhood Care and Pre-school Education

Some services are provided directly by ICDS programme while services like immunisation,
health check-up and referral services are provided in convergence with the Health and Family
Welfare Department. The convergent functions being utilisation of Anganwadi centres (AWCs)
as a common platform for service delivery and coordinated planning and organising of service
delivery by Anganwadi worker (AWW) and Health functionary (ANM/ LHV/ Mitanin/ Sahyogini/
ASHA workers) at village level.

In the implementation of ICDS, different States /UTs have adopted innovative approaches to
enhance the effectiveness of their efforts which is being dealt in this section.

The purpose of this section is to learn from the ‘good practices in ICDS’ and look at best
context-specific options for up scaling and replication in other States, where conditions are
appropriate. Besides the above, the use of the section is to capture how effective the
interventions are and identify indicators of change. Best Practices for each of the services of
ICDS were identified through literature review of the ICDS programme implemented within
the States/UTs in India.

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 POTENTIAL GOOD PRACTICES – THE ICDS EXPERIENCE

2.1. Good Practices in Early Childhood Education

The early learning component of the ICDS is a

significant input for providing a sound foundation for
cumulative lifelong learning and development.
Preschool education (PSE), as envisaged in ICDS,
focuses on holistic development of the child, aged
up to six years. The programme for the 3-6 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. For the Pictorial books
vast majority of disadvantaged children in India, ICDS
is the only avenue so far for providing preschool
education. But there is overwhelming evidence that
the preschool education component of the ICDS
scheme is particularly deficient in quality, and almost
non-existent in anganwadis, in some parts of the
country. Nevertheless, some States have taken
initiatives towards improving the quality of preschool
education. These are illustrated below. Instruction Material

2.1.1 Initiatives in Early Childhood Care Education (ECCE) in Rajasthan

The State has established a State level Coordination Committee having linkages with SIERT,
NCERT, UNICEF and some reputed NGOs. The committee initiated following innovative
measures for strengthening the PSE component.

• Establishment of a Child Media/Resource Laboratory for material development,

operational research, advocacy etc.

• Appointment of NTT trained in 500 tribal Anganwadi Centres in ICDS under Tribal Sub
plan.

• Strengthening of ECCE at grass root level

through community ownership in 9 districts
and functioning of District level Coordination
committees through DIETs. Community-
based monitoring system through network of
PRIs, youth, old people is put in place.

Community Sessions

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 POTENTIAL GOOD PRACTICES – THE ICDS EXPERIENCE

• With the help of DIETs, an ECE experimental pilot project is also being implemented in
nine districts of the State. Each DIET of the state has also adopted 25 AWCs to develop
them as Child-Friendly Centres (CFCs). Audio CD of ECE songs, rhymes, riddles and
an animation film to advocate the concept of ECCE have also been developed in the
state with the financial support from the UNICEF. Other innovation, which the state of
Rajasthan is trying out, includes joint training of AWWs with Primary School teachers,
evolving community-based monitoring system to strengthen ECE in CFCs and creation
of ECE resource faculty and resource centre in all DIETs of the State.

2.1.2 Early Childhood Education in Tamil Nadu

Tamil Nadu has been one of the first States to have given importance to ECE and high level
advisory committee has been constituted so that quality education is delivered through ICDS.
Some of the initiatives undertaken by the State are:

• Development of ECCE Curriculum: Working Committee was formed to develop a

curriculum for ECCE called Odi Vilayadu Paapa, through a consultative process involving
ICDS cadres; subject experts and Block Resource
Trainers and primary school teachers of SSA. The
curriculum is intrinsically linked with Activity-Based
Learning (ABL), the pedagogy currently practiced
in primary classes in Tamil Nadu. Monthly
framework and weekly and daily activity plans have
been prepared for the transaction of the curriculum.
The framework comprises of Seidhu Arivom
(Individual Choice Time), Pesi Padi Magizhvom
(Circle Time), Vilayadi Karpom (Structured Play),
Arindhu Magizhvom (Concept Time) and the daily
activities are conducted according to the monthly
and weekly framework. The domains addressed in the bilingual curriculum include
(a) sensorial alertness (b) physical growth needs (gross and fine motor development,
coordination, balance) (c) self-care life skills education (food, toilet, cleanliness,
participation in daily life) (d) communication (listening, responding, speaking,
conversation), (e) social-emotional development (moral, social) (f) cognitive development
(concept formation, discrimination, pre-reading, pre-writing, pre-math, imagination).

• Development of PSE Kit: This has been done in convergence with Sarva Shiksha
Abhiyan (SSA) in Tamil Nadu. Each AWC gets two types of kit materials in alternative
years (Kit A & Kit B). It comprises of material for individual choice, activities consisting of
wooden and plastic blocks; jigsaw puzzles; balls; stacking cups; coloured beads;
geometric pin board; lacing boards; shape and colour sorter; wooden numbers; English

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 POTENTIAL GOOD PRACTICES – THE ICDS EXPERIENCE

and Tamil alphabet inlets; shape, size and colour of game; sorting and sequencing frame
and mazes.

2.1.3. Initiatives taken by Gujarat in Early Childhood Care Education

At least four out of five 3-4 year old children in Gujarat attend Balwadis or Anganwadis; by
age 5, an estimated 3 out of 4 children have moved into primary school, but they are too
young and not developmentally ready, affecting their ability to learn and stay in school. In
2009, with assistance from UNICEF, the Government of Gujarat, tried to improve ECE through
a pilot initiative in two districts and took the following measures.

• Development of Standards and Indicators: Standards and indicators to assess children

between the ages of 3 to 6 years were developed. A total of 23 indicators were selected
across all domains of development namely physical, social, emotional, cognitive, linguistic,
approaches to learning, creative arts and values.

• Toy Bank Initiative: With the extensive support from community, community-based
organisations, NGOs and the officials of DWCD, the Government of Gujarat have explored
the idea of setting up a Toy Bank to provide deprived children the opportunity to play with
toys and experience play way learning. Through this initiative, the joyful learning
opportunities are being provided for better cognitive, social, emotional and physical
development. There are about 17 lakh children covered by around 25,000 AWCs in the
state.

• AWCs School Enrollment Drive – Shala Praveshhot in Gujarat: In order to boost on

Education for All and bring down the drop-out rate at school, every year in June, a massive
drive is being conducted in the State of Gujarat wherein all the eligible children are enrolled
in their respective AWCs and eligible children of AWCs get enrolled to primary Schools.
This drive has the patronage of Hon’ble Chief Minister, State Ministers, officials of State
Government and other dignitaries.

2.1.4 Initiatives in Early Childhood Care Education in Andhra Pradesh

The State has developed Preschool kit for each AWC by engaging Andhra Mahila Sabha.
The kit consists of child-friendly and developmentally appropriate play and learning material,
story cards, flash cards, puppets etc. A Pre-School syllabus for 10 months and Activity book
(Aduthu Padhuthu Module), story cards (Chitti Patti Kathalu) have been prepared as teaching
mater. The state has also introduced a system of issuing Pre-School Certificate for 5+ children
who leave AWC to join Class I.

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 POTENTIAL GOOD PRACTICES – THE ICDS EXPERIENCE

Table 1: Initiatives to Strengthen Preschool Education in Some Other States

State ECCE Policy Chhattisgarh

Curriculum/ Activity Books Thematic Curriculum (Andhra Pradesh,

Assam, Chhattisgarh, Karnataka, Madhya
Pradesh, Punjab, Tripura ), Calendar of
Activities (Bihar), Activity Books (Orissa,
Punjab, Bihar, Chhattisgarh, Karnataka),
rhyme and song books (Assam, Tripura)

Celebration of ECCE Day Bachpan Divas ( Bihar ), ECCE Day

(Karnataka), Bal Sabha (Madhya Pradesh),
Kanya Kelavani (Gujarat)

Child-Friendly Anganwadis AWCs based on BaLA (Building as Learning

Aid) concept (Madhya Pradesh, Karnataka)

Awarding of Preschool Certificates Andhra Pradesh

Uniform for Children Sikkim and many other States

2.2. Initiatives for Improving Management of Supplementary Nutrition

Supplementary nutrition is an essential service of ICDS. It

provisions for dry ration for children between 6 months - 3
years and pregnant and lactating mothers, thereby ensuring
availability of food at the critical period of an individual life
cycle. Morning snacks and hot cooked meals are provided
to children (3-6 years) who attend the Anganwadi centre
daily for preschool education. The States are delivering
this service through several innovative ways especially for
procurement and supply chain management.

There are about 10 initiatives in this domain in 10 states -

Gujarat, Kerala, Tamil Nadu, Madhya Pradesh, Andhra
Pradesh, Chhattisgarh, West Bengal, Orissa, Uttarakhand
and Rajasthan. Eight initiatives depict varied institutions
through which the SNP is supplied. The initiatives are cited Menu for Supplementary Nutrition
in following table.

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 POTENTIAL GOOD PRACTICES – THE ICDS EXPERIENCE

Table 2: Supplementary Nutrition — Supply and Procurement

Initiative Brief Description

Gujarat’s model (Gujarat) – Weekly recipes for the AWC charted out and
followed
– Fortified THR: Four premixes (Bal Bhog, sukhadi,
upma, sheera) for preparing around 77 recipes
– Rasoi shows are organised for orientation on
benefit and preparation of premixes
– Community contribution and participation on
special days

Kerala’s enterprise groups – THR is being provided through 396 enterprise

(Kerala) groups (CPCRI). Three gram panchayats are
being covered by 1 enterprise group. This is
monitored centrally.
– Within Kudumbashree Mission of Ministry of
Panchayati Raj and Rural Development, crisis
management fund has been created which was
utilised for SNP purchase.

Weaning food by women’s – 25 women cooperatives involved in preparation of

cooperative (Tamil Nadu) weaning food.
– Recipe chart for the week is drawn and followed.
– Diverse recipe with 3 eggs / banana given every
week.

Sanjha Chulha (Madhya Pradesh) – Common chulha/ cooking arrangement are

maintained in convergence with MDM to cook
food.
– Morning snacks and lunch cooked by SHGs is
supplied to AWCs.

AP food Model (Andhra Pradesh) – The state of Andhra Pradesh provides semi-
processed foods like the suji/ semolina, upma,
halwa which are pre-mixed with either salt or
sugar and need simple cooking procedures at
household level (for THR) or at AWC (for spot
feeding).

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 POTENTIAL GOOD PRACTICES – THE ICDS EXPERIENCE

Initiative Brief Description

Commodity supplies managed – Women groups in the community are allocated

by women Self-help Groups AWCs for which they are required to purchase
(Chhattisgarh and several pulses, soya, condiments, oil etc. and provide
other states) them to the AWW on a daily basis for spot-feeding
and for THR distribution on a weekly/ fortnightly
basis.
– The AWWs and the SHG members together
manage the THR distribution.
– ICDS pays the SHG for these supplies on a
periodic basis. The rice for the feeding
programme of ICDS is routed through the fair
price shops of PDS.

Decentralisation of procurement – West Bengal have delegated the procurement-

and supply to districts and related decision making to the district level for
blocks(West Bengal and some of the commodities like pulses, and to the
Uttarakhand ) block level for other minor commodities while rice
is supplied through PDS/ civil supplies
corporation.
– In Uttarakhand, the hot cooked meal is provided
by mother’s committee and fund is directly
transferred to their bank account.

Decentralisation of procurement – Fixed weekly schedule for morning snacks and

and management of hot cooked meal
commodities to AWC level – Rice supplied through FCI, for remaining
(Orissa) ingredients procurement decentralised to village
level
– AWW and select mothers as members to manage
the local purchase of food commodities; joint
accounts held; e- transfer done by 7th of every
month
– Jaanch Committee formed at the village level
(comprising of retired government officials, SHG
presidents, members of mothers committee etc.)
– Monthly monitoring at GP level
– Greater involvement of PRI & community

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 POTENTIAL GOOD PRACTICES – THE ICDS EXPERIENCE

Initiative Brief Description

Engaging SHGs to supply – Women members of SHGs/ SHG federation are

processed food to AWCs offered contracts by ICDS to supply processed
(Orissa and Rajasthan) foods (THR)
– Standardised packaging of THR with details of
date of manufacture, ingredients, method of
use etc.

Daily distribution of hot-cooked – In case of select cities and sub-urban areas in

meals by private sector several States/UTs, ICDS has involved non-
involvement (Delhi, Rajasthan, governmental agencies like Akshya-patra
AP, Gujarat) Foundation and Naandi foundation, Non- Profit
Organisations (NPOs) etc. to provide hot cooked
food to feeding centres on a daily basis.

2.3. Nutrition, Health Education and

Counselling

It is a major component in ICDS programme to

ensure that mothers/ parents / community receive
health and nutrition education. The AWWs are
primarily responsible for making home visits for
educating parents and families of children below
three years who are not attending the AWCs so
that the mother/ family of the child is enabled to
play an effective role in child’s growth and
development. Specific practices related to
Nutrition and Health Education (NHED) seen in Counselling during Home Visit
different States are cited here.

2.3.1 Nutrition Counselling and Child Care Sessions in Positive Deviance, West
Bengal

Intense nutrition counselling and child care sessions were implemented in the positive deviance
project, where care givers of moderate and severe undernourished children are provided
intensive counselling sessions (for 12 consecutive days) by AWWs and the supervisors. Along
with supervised feeding for the undernourished children, thematic demonstrations and
counselling sessions are conducted on all 12 days to caregivers.

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 POTENTIAL GOOD PRACTICES – THE ICDS EXPERIENCE

2.3.2 Nutrition Education in Tamil Nadu Integrated Nutrition Programme (TINP)

Nutrition education was provided to all mothers who maintain contact with the centre. Monthly
education and demonstration sessions were held either at the Child Nutrition Centre or at the
home of one of the mothers. One innovation of the TINP in this context is the women’s working
groups (WWG). Mothers got together to form small groups, one mother assuming the role of
the leader and the Child Nutrition Worker, acting as a group facilitator. These group meetings
were the focal points for nutrition education and in some areas, for income-generating activities.
In some centres, the leader of the women’s group was encouraged to assume charge of 10
other women in the locale, whose continued participation is ensured by the leader. Children’s
working groups were also initiated in some of the project areas wherein member children
educate other children and adults about simple nutrition/health-related messages through
songs and jingles. The communications component of the programme focused on organisation
of special campaigns and drives on topics of common interest.

2.3.3 Use of Media for Health Education

Health Education on 52 thematic areas related to adolescent reproductive sexual health,

maternal health, child health and family planning is aired on Doordarshan. The service providers
(ASHA) will be sensitised and provided with health bulletin (Booklet on health messages on
52 themes) to help facilitate group discussion in Gram Kalyan Samitis on monthly thematic
areas.

2.3.4 Sas Bahu Sammelan

In Uttar Pradesh, joint meetings of daughters-in-law, mothers-in-law, elderly ladies of the family,
female PRI members, ICDS functionaries, NGOs and
women’s groups were organised. These meetings provided
the stakeholders a common learning platform. The meetings
were held once every year at the district and block levels.
At the district level, the Addl. CMO (RCH or Maternal Health)
and at the block level the MO was responsible for organising
such meetings in coordination with ICDS staff. An agenda
for the same was prepared well in advance. During these
meetings, women's health issues, role of various family
members, harmful social practices & beliefs, significance
of nutrition, information of various programmes and Annaprasan
schemes, role of other stakeholders in improving health
practices in the community were addressed. The meetings were also videographed and
useful feedbacks documented thereby helping in refining communication strategies,
development of communication material and interventions.

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 POTENTIAL GOOD PRACTICES – THE ICDS EXPERIENCE

2.3.5 Mangal Diwas, Madhya Pradesh

In Madhya Pradesh Mangal Divas is observed in ICDS. Every

Tuesday events like Janamdin, Ann Prasan, Godbharai and
Kishori Divas are organised with small celebrations signifying
complete immunisation, introduction of complementary feeding
after six months of age, early registration of pregnancy and
importance of adolescent period respectively. Both Health and
ICDS functionaries jointly conduct Mangal Divas. Similar practice
is also observed in Uttar Pradesh.

2.4. Convergent Models for Improving Health Services Godbharai

through ICDS

A single concept of Village Health and

Nutrition Day (VHNDs) mandated under
NRHM, is in practice in all the states. A fixed
day and site approach with joint planning
of ICDS, Health and PRIs encourages
community involvement and mobilisation
and appropriate logistics management for
a basket of services to be delivered. These
include Immunisation, micronutrient
supplementation, health check-up, ANC, Village Health & Nutrition Day
PNC, counselling and referral. The
approach has shown rapid increase in access of health and nutrition services to remote and
unreached locations. Provision of THR for pregnant and lactating mothers adds as an incentive
to attract pregnant and lactating women and children below 3 years to the AWC. The approach
also enables common monitoring and reminder to the drop outs. In conducting these VHNDs,
effective community and PRI support has been forthcoming in most States.

2.4.1 Variations in Village Health Nutrition Day

• HMRI / 104 initiative : The monthly fixed-day fixed-site health service provision through
mobile team being implemented in states like AP, Gujarat and Uttarakhand is example
of further adaptation of the HMRI or 104 initiative concept of VHND to suit to the local
needs and resources. In AP, 104 initiative deploys mobile health units (MHUs) to render

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 POTENTIAL GOOD PRACTICES – THE ICDS EXPERIENCE

4 hours service once a month in each habitation with a population of 1,500. Each mobile
health unit covers two habitations in a day and 56 villages a month.

• Fixed Nutrition and Health Days under INHP (FNHD): It combines the principles of
fixed day, fixed-site provision of outreach services such as immunisation, antenatal care,
and food supplement distribution, health and nutrition education with the principles of
convergence of services and community participation and monitoring. Processes
involved include preparation of roaster by PHC of every habitation with specific dates on
immunisation. VHND in some States is so planned that it coincides with the dates of
THR distribution. Prior to FNHD, ANM and AWW list children and pregnant and lactating
women due for vaccine and antenatal check- up and invite them in advance. This list is
reviewed at the end of the day and reminders are sent to families. During the FNHDs line
department functionaries and community leaders are involved to ensure check and
balance. The AWW, AW helper, ASHA and ANM together with local volunteers organise
the FNHDs such that waiting time is minimised for the mothers and caretakers who
bring children.

• Mamta Diwas: Village Health and Nutrition Day (VHND), Mamata Diwas, a concept for
interdepartmental convergence having desirable health outcomes of children below five
years, is being introduced in the State of Orissa by the Department of Health & Family
Welfare. The programme is organised once a month in every Anganwadi Centre on a
fixed day basis (either Tuesday or Friday) with joint efforts of ANM, AWW and ASHA. On
an average, there are six to eight AWCs under the operational jurisdiction of one Sub
Centre and thus there would be about eight fixed days in a month per Sub Centre. Advance
Such days should be fixed beforehand in consultation with all AWCs for the entire month,
so that the service providers and the community are aware of it much in advance.

2.4.2 Referral Services in ICDS

During health check-ups and growth monitoring sessions, sick or undernourished children, in
need of prompt medical attention, are referred to the Primary Health Centre or Sub-Health
Centres. The anganwadi worker has also been oriented to detect disabilities in young children.
She enlists all such cases in a special register and refers them to the medical officer of the
Primary Health Centre/ Sub-centre. States like Madhya Pradesh, Maharashtra, Rajasthan
and few other States under NRHM have established Nutrition Rehabilitation Centres (NRCs)
at the district hospitals and CHCs. ICDS extends support in referring children with medical
complication to these centres.

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 POTENTIAL GOOD PRACTICES – THE ICDS EXPERIENCE

These referral services are essential in meeting urgent needs of the sick and undernourished
children. The referral mechanisms in different States /UTs are cited below:

• Pustikar Diwas in Orissa: Health and Family Welfare Government of Orissa in

collaboration with Women and Child Development Department observes “Pustikar Diwas”
on the 15th day of every month at the Block PHC/CHC level for effective management,
treatment and referral of undernourished and sick children under five years of age. ICDS
functionaries from each of the Anganwadi centre prepare a list of beneficiaries for referral.

• Referral Mechanism of Undernourished Children in Madhya Pradesh: An incentive

of Rs. 100 is paid to AWW for identification of severely undernourished children with
medical complication and accompanying child and caregivers to Nutrition Rehabilitation
Centres (NRCs) at the district or block level.

• Referral from Village Child Development Centres (VCDC) in Maharashtra: The

AWW conducts feeding sessions for 30 days providing three additional meals apart
from the routine SNP. Antibiotics and micronutrients are given under supervision of the
health department. The VCDC opens for 4 hours in the morning and 2 hours in the
evening which is supervised by MO and ICDS Supervisor. Children gain weight within
30 days. From these centres the AWW identifies undernourished children with medical
complication based on weight for age, while height measurements and wasting criteria
are certified by health officer before referral to health facility.

• Referral of Undernourished Children in Karnataka: Severely underweight children

are provided food and medicine @ Rs. 750 per child. Neonatal and severe
undernourished children are referred to 6 identified hospitals.

• Indira Bal Swathya Yojna in Haryana: The scheme provides for health check-up,
health cards and medicine for undernourished children of BPL families. Linkages of
ICDS for referral with Medical institutes - PGI Chandigarh, Rohtak Medical College and
AIIMS, Delhi have been created for providing free check-up to these children.

2.4.3 Event-based Initiatives and Campaign-based Activities

Several health-related services like immunisation, Vitamin A supplementation are effectively

delivered at the village level in a campaign mode or observed as an event.

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 POTENTIAL GOOD PRACTICES – THE ICDS EXPERIENCE

A list of such activities is cited below in Tables 3 and 4.

Table 3: Event-based Initiatives

Innovation State Brief Description

Jacha Bacha Uttarakhand – A camp approach; fixed day visit schedule for
Swasthya Divas providing ANC and child health services in all
villages located in a sub-centre area on a
rotational basis.
– ANMs provided Rs. 50 per camp for assisting in
handling equipment and supplies.

Mamta Abhiyan Gujarat – It comprises of four components- Mamta Divas,

Mamta Mulakat, Mamta Sandarbh and Mamta
Nondh
– Mamta divas is a fixed Day when Health and
nutrition services, immunisation, ANC,
distribution of Supplementary Nutrition, Growth
monitoring and counselling and critical services
are delivered.
– Mamta Mulakat is post natal visit by AWW, ANM
during first week and first month of life.
– Mamta Sandharbh is provision of referral by
AWWs.
– Mamta Nodh Service AWWs and ANMs fill the
Mamta Card carried by pregnant and lactating
women.

Haat Clinics in Gujarat – A temporary camp is held in the markets where

Tribal areas doctors and other staff are deputed on a rotation
basis.
– The camps provide services on minor ailments
and vaccination.
– Awareness generating activities are also
undertaken during these camps.

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 POTENTIAL GOOD PRACTICES – THE ICDS EXPERIENCE

Innovation State Brief Description

Annual Andhra – A campaign in all Gram Panchayats for anaemia

Deworming Pradesh control in children (3-12 years) based on clinical
symptoms.
– Children are administered IFA and deworming
tablets.
– Sensitisation workshops are conducted in each
habitation with the target groups to obtain the
support and participation of all families in the
campaign.

Bal Swasthya Uttar Pradesh, – Biannual Vitamin A supplementation along with

Poshan Mah Madhya intensive promotion of exclusive breastfeeding,
(BSPM)/ Bal Pradesh, complementary feeding, iodised salt
aposhan Mah Other states consumption and referral of severely
for Micronutrient undernourished children are organised in the
Malnutrition fixed months twice a year.

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 POTENTIAL GOOD PRACTICES – THE ICDS EXPERIENCE

Table 4: Campaign Mode Initiatives

Innovation State Brief Description

Well Baby Andhra – Well Baby shows organised in all the Gram
campaigns Pradesh Panchayats where children below one year are
assessed on the basis of their immunisation
status, nutritional status and milestones for
growth and development.

Vaccine Delivery Bihar – Maximising the coverage of immunisation and

through Mobile Vitamin ‘A’ supplementation through the strategy
vans of mobile van approach to cover inaccessible
areas.

Panchamrit Rajasthan – A week-long intervention programme for Mother

Campaign and child Health and nutrition Camps are held
during the first three months of the year.

Annual Andhra – One week per year is dedicated for tracking of

immunisation Pradesh all mothers and children based on their
census immunisation status.
– The women health volunteers, AWWs and ANMs
form teams and conduct the surveys,
simultaneously giving mop-up immunisation for
non-immunised children.

Young infant Andhra – A voucher scheme, enabling infants of rural BPL

health assurance Pradesh families to access the services of the private
scheme sector hospitals, paediatricians and general
medical practitioners in small towns and large
Panchayats for health care services.

Muskaan Bihar – Identification of all beneficiaries (pregnant

women and children under two years of age) and
tracking to ensure complete immunisation
coverage.
– Increasing the number of sessions so that
immunisation services are provided in all health

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 POTENTIAL GOOD PRACTICES – THE ICDS EXPERIENCE

Innovation State Brief Description

sub-centres on Wednesdays and in two to three

anganwadi centres on Fridays.
– Introduction of performance-based incentives and
penalties to community mobilisers as well as to
providers at all levels of the service system.
– Village-level mahila mandals served to sensitise
mothers to the benefits of immunisation.

Catch-up Jharkhand – A package of services - vaccines, IFA,

Rounds for deworming, Vitamin A and surveillance for
Immunisation and malaria and TB in the catch-up round are being
Zero Diarrhoea provided on a biannual basis to “the last person
Programme in the last household to the last village”.

Mother and Assam – During the MCH month, the emphasis is on the
ChildHealth Month provision of the services to be provided at the
sub-centres, anganwadi centres (AWCs), during
Village Health and Nutrition Days (VHNDs) and
out-patient departments of all health institutions;
these service include Vitamin A prophylaxis up to
children of three years, deworming of children
between one to five years, treatment of anaemia
in children between one to five years (IFA small
tablets), treatment of ARI cases and cases of
dehydration with ORS and zinc tablets.

Hirkani Kaksha Maharashtra – A scheme for promotion of exclusive

breastfeeding of infants which provides the
facility of a special room/kaksha where working
women can breastfeed her child in privacy. There
are facilities also for storing the breast milk of
working women who are into exclusive
breastfeeding to be used later.

Immunisation Kerala – A campaign to strengthen immunisation

Drive coverage in the State through intensive IEC/BCC
campaigns and inter-sectoral convergence of the
ICDS, Education and Health departments.

30
 SECTION - C

PRACTICES FOR
IMPROVED PROGRAMME
MANAGEMENT
 POTENTIAL GOOD PRACTICES – THE ICDS EXPERIENCE

3 Improving Programme Management in ICDS

ICDS is a well-designed programme but faces the challenge of good implementation. This is
primarily due to issues related with programme management. States/ UTs realise the
importance of the programme and have tried to bridge several of these gaps. Integrated
approaches have introduced several management components into ICDS which have
provided systemic strength.

Good management on the ground and effective use of information along with community
participation has brought success to several community-based programmes, like ICDS.

Important managerial reforms in ICDS could focus on community processes like community
mobilisation, community engagement and participation, human resource development,
behaviour change communication, convergence etc.

ICDS programmes has no clear cut directions in community processes, it depends on

individual workers and their proactive approach in engaging community. Integrated pilots
have explored the effects of community processes to realise important objectives, especially
those pertaining to change in care behaviours and reduction in under-nutrition.

The other set of managerial reforms would include quality data collection, analysis for
differential planning and supervision for improved action at community level. ICDS today
generates a large quantum of data, which is left unused and the quality has often been
questionable. The large number of registers, the flow of data and rigorous procedures make
the process tedious especially for the Anganwadi worker. Some states have realised the
importance of quality data and have simplified the reporting pattern, brought in the use of
web-enabled MIS and GMIS for surveillance, monitoring through ICT. These are quite a few
examples in ICDS.

This section intends to collate some of these experiences and study the feasibility of scaling
up these practices and processes.

3.1 Community Mobilisation

In several state ICDS programme and development agencies have used innovative
approaches to adapt prevailing cultural practices/ customs/ ceremonial occasions to promote
specific set of behaviours and to enhance community participation in ICDS. In projects like
Dular, ASAT and INHP, it was done by a band of local women called local resource persons

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 POTENTIAL GOOD PRACTICES – THE ICDS EXPERIENCE

(LRPs), Gram Sampark Samooh (GSS) or

Change Agents respectively. These women were
often assigned households in their
neighbourhood to support the target families for
behaviour change. They were provided two or
three rounds of training on critical maternal and
child health and nutrition issues and were often
equipped with some basic communication aids
for talking to mothers.

3.2 Use of Monitoring Tools Community Mobilisation

It is a necessity in contemporary scenario to

support planning of services, tracking of
undernourished children and utilisation of
ICDS services and monitoring of AWCs.

In ICDS monitoring tools like community

growth chart, mother & child protection card
have been in use since long. Integrated
projects implemented through the ICDS
channel have used these tools widely and
these are found to evoke excellent community
Use of monitoring tools response. In addition social mapping, colour
coding of tools in ASAT, INHP and PD have
been an effective exercise generating extensive community participation in monitoring of
health and ICDS services. Mapping and colour coding proved to be powerful communication
and monitoring tools in Positive Deviance Approach. In INHP, use of innovative pictorial tools
for families to track service utilisation and behaviour change from pregnancy till the child is
two years old were useful for families to remember services and behaviour. Currently colour
coded Mother and Child Protection Card (MCPC) is used in ICDS both as an IPC tool, and a
self-monitoring tool. The use of community growth charts is found only in very few states and
should be revived.

3.3 Community Participation and Monitoring

Several states have taken special efforts to involve community groups like SHGs, mothers
groups, PRIs etc. in participating and monitoring of day to day functioning of AWCs. In Gujarat
formation of matru community (mothers groups) provides support on Tithi Bhojan days by

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 POTENTIAL GOOD PRACTICES – THE ICDS EXPERIENCE

contributing vegetables. In the state, community participation is enhanced through rasoi shows
and competitions. In Kerala Village level monitoring of AWC is done by ward members and
panchayat level health education committee. Two AWCs are assigned per member /
committee in Tamil Nadu, for bringing children to the centre. They contribute to providing play
materials, construction of infrastructure and maintenance of kitchen garden. Madhya Pradesh
has identified high burden districts and blocks in these areas: one person from the community
is identified to monitor 15 households and ensure service uptake from health and ICDS
infrastructure. Odisha has set up monitoring committee (Janch Committee) for monitoring
SNP, photo display of these members are available at AWC. Monthly monitoring of AWCs is
also done at the GP level.

3.4 Incremental Learning and Supervision

Supervision has itself been a

challenge in programme
management. ICDS supervisors
were appointed for supervision and
support to the AWW. The number
of centres devolved per supervisor
is high to provide substantial
supervision. Programmes of
UNICEF, CARE and World Bank
that supported ICDS
implementation have focused on
improving the supervision system
and to strengthen mechanisms for
Interpersonal Counselling
on-going capacity building of
workers through different
mechanisms. In INHP supervisory checklists were designed in a participatory manner focusing
on critical behaviours and services. Based on trends denoted from checklist and interaction
with AWWs, the supervisors were helped to develop and conduct capacity building (CB)
sessions for AWWs during the monthly review meetings at sector level. Additional block level
nutrition instructress within TINP, ASAT, Dular and INHP utilised external resource persons;
including local NGO staff, master trainers etc. to help the ICDS staff to conduct supportive
supervision and to provide on the job capacity building inputs. In Jharkhand, selected AWWs
were designated as cluster coordinators and were assigned additional responsibility to support
about 10 to 12 AWWs around their village.

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 POTENTIAL GOOD PRACTICES – THE ICDS EXPERIENCE

3.5 Behavioural Change Communication

It is one of the strategies to sustain positive behaviours practices within the community.
Community listens, speaks, learns, understands and analyses their behaviours vis-a-vis the
positive ones and adopts, depending on support. MCHN and Dular conducted interpersonal
counselling for Behavioural Change Communication. Dular strategy used flash cards for
Interpersonal counselling by AWW during home visits. IPC involves social interaction creating
awareness, building knowledge and emphasising on its practice. This BCC can be sustained
by reemphasising the messages through continuous interactions during home visits, group
counselling, community meetings etc.

3.6 Convergence

Programme Convergence essentially tried to bring together ICDS and health functionaries to
jointly identify issues and plan appropriate actions in setting the agenda, facilitating quality
discussions, and reviewing data from district and block, monthly progress reports and field
visit observations. It also helped to overcome deficits by leveraging both physical and
intellectual resources. Most of the integrated projects have tested different models for
convergence between ICDS and health functionaries at sector, block and district levels for
joint planning, review and solving operational problems. While most of these efforts were
focused around ensuring joint monthly or quarterly meetings of multiple stakeholders at block
and district level, some efforts were made to bring together all ANMs, ASHAs and AWWs
together at sector level on a monthly basis. Block and district level convergence forums
reviewed the programme implementation and provided guidance to solve any operational
problems. Convergence in itself is a challenge as working it out needs a clear agenda and
mechanisms in place for flow of information.

3.7 Programme Monitoring and Management Information System

States have tried to improve their monitoring mechanisms and have taken several steps
related to it, which include simplification of reporting formats, web enabling of MIS, introduction
of GIS for the purpose of surveillance and financial monitoring. Some of these initiatives for
improved and timely reporting have been undertaken with the support of Development Partners
and other technical agencies. Civil societies and NGOs have added a new dimension to
programme monitoring in ICDS by the introduction of public participation in conducting social
audits and opening up channels of dialogue with providers and receivers, through public
hearing.

36
 POTENTIAL GOOD PRACTICES – THE ICDS EXPERIENCE

Some of the innovations are enlisted below.

• Nutrition Surveillance System (NSS): Pioneered by States of Chhattisgarh and

Maharashtra, Nutrition Surveillance System locates and tracks every month all severely
malnourished children by name and by location, and captures ICDS data from all
Anganwadi centre of the State. It brings out meaningful information through analysis and
reports to higher levels of appropriate authority by collating the data as per requirement
at each level. Introduction of NSS made valuable data useable at different levels by
ensuring easy analysis and feedback to improve performance. The analysis through
NSS was done in the following ways: Area wise analysis (project wise, sector wise and
anganwadi centre wise); Indicator wise analysis (nutrition indicators as total under-nutrition
disaggregated by age and health indicators as Maternal and Child Deaths); Time wise
analysis through graphs generated at all levels (AWC, Sector, Project, District and State
levels); and dual maps generated through GIS which give the time series analysis. Data
analysed through the geographic information systems (GIS) embedded in the software
is a potential tool for sensitising functionaries on various performance indicators of ICDS
as well as prepare action plans for improving low performing indicators or areas. Analysis
shows that over a period of time, the reporting system of ICDS has shown improvement
both in terms of quantity and quality.

• GMIS in Andhra Pradesh: The system has been piloted in 3 districts of the state. The
AWW is trained to enter beneficiary wise data on laptop installed with software. At the
sector level, the reports are generated on information such as drop outs on immunisation,
growth monitoring etc. At the sector level data is uploaded to central server, where reports
and data are used by CDPOs and supervisors for planning and monitoring. Gaps and
issues are displayed as geographical representation to identify clusters/sectors which
require more attention and focussed interventions.

• Web-Enabled MIS: Madhya Pradesh and several other States have established web-
enabled MIS. Monthly Progress reports are being received at the State Directorates
online. The existing monthly reporting format was revised to capture relevant and
appropriate information aiming to enhance personnel efficiency, more effective use of
data and sustainability for actions. It reduces the drudgery of manual data transfer and
generating several copies of the same.

The new streamlined monthly progress report saved significant amounts of staff time (AWWs
said they previously spent 2 to 3 days completing the report, which now takes less than an
hour), leaving more time for service provision; they also found it simpler to complete and
therefore made fewer mistakes and provided more accurate data, thus the form supported
improved service planning and delivery. The web-enabled MIS provided up to date information,

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 POTENTIAL GOOD PRACTICES – THE ICDS EXPERIENCE

saved staff time (supervisors, statistical officers, Child Development Project Officers);
improved supervision and coordination between AWWs, supervisors, CDPOs; and increased
access to and use of information at all levels.

3.8 Transparency and Accountability in ICDS

In recent years, several States have

taken keen interest in critically looking
at the implementation of ICDS and
streamlining this flagship programme.
NGOs and civil societies, have
conducted social audits with the support
of district administration.

The drought-prone Anantapur district of

Andhra Pradesh was the first in the
country for public evaluation and social
auditing of the ICDS. The audit of the
ICDS programme was conducted on 24- Social audit in Progress

25 September 2008. Thereafter similar

social audits of the ICDS programme have also been held in various places of Odisha namely
Mirdhapali Gram Panchayat of Bolangir district, Ratakhandi Gram Panchayat of Loisingha
block of Bolangir and in 14 Gram Panchayats of Koraput district.

Organisations like Care India and FORCES in coordination with the authorities have also
been conducting social audits in different states of India like Uttar Pradesh, Bihar, Rajasthan,
Jharkhand and Delhi. The social audits have not only increased transparency in ICDS, but
also provided critical inputs for strengthening service delivery and taking important decisions
related to functioning of the AWCs.Public hearings have also been held in ICDS, in Allahabad
slum; public hearing was held to identify public grievances and find solution.

3.9 Initiatives in Financial Management

Financial Management is a vital component for effective implementation of ICDS. Few states
have already initiated streamlining data management by incorporating effective data mining
and data warehousing techniques along with the timely reporting of financial details in the
form of Statement of Expenditure (SoE). Unlike initial years of ICDS, it is now possible to
calculate the financial status of States pertaining to various components constituting ICDS
(G). Besides, different modules for real time data monitoring are in pilot stage to be rolled out

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 POTENTIAL GOOD PRACTICES – THE ICDS EXPERIENCE

in near future. Examples of few States like MP, Chhattisgarh, Maharashtra, and AP can be
considered as benchmarks for imbibing technology into ICDS for better control of funds in
order to optimise the expenditure within the prescribed budgetary constraints. AP has
pioneered Geographical Information System (GIS) technology for mapping AWCs thereby
enabling a linkage of operational and financial MIS. Maharashtra has separate module for
FMIS. Likewise, MP is planning and controlling funds with the help of in-house developed
software like Mudra and Mudra Prahari as well as real time financial data is reflected through
its treasury website (online financial system).

Despite the lacunae like lack of human resource, hold of funds by State finances, less flexibility
and decentralised planning, efficiency of fund utilisation has shown some improvement but a
still a long way to go in order to achieve noticeable impact. With this motive, process for
developing a web-enabled online financial monitoring system at National level is already in
place, and expected to serve as a key step for streamlining the financial system of ICDS.

39
 SECTION - D

SNAPSHOT OF SOME
OUTSTANDING PRACTICES
 POTENTIAL GOOD PRACTICES – THE ICDS EXPERIENCE

4 Snapshot of Selected Good Practices

A ‘practice’ is generally defined as a ‘way of doing things in a usual or expected manner’.

Different definitions of ‘Good Practice’ imply a practice with various special characteristics
such as innovativeness, ability to lead to an actual change, having an impact on policy
environment, replicability and sustainability. A best practice could also be distinguished by its
contribution to increase the efficiency of the initiative (that is, optimum use of resources to
enhance outputs and outcomes) or its effectiveness (that is, its contribution to the achievement
of the set objectives of the scheme in which the practice occurs). In its implementation, several
States/ UTs have adopted unique approaches to enhance the effectiveness of ICDS. The
section gives a snapshot of such initiatives.

4.1 Construction of Anganwadi Centre, PPP Model, Tamil Nadu and Gujarat

Lack of well-designed
centre with all amenities
to provide a joyful
learning environment is
one of the major
constraints of ICDS.
States like Tamil Nadu
and Gujarat have
overcome this through
Public Private Partner-
ships (PPP). In Tamil
Nadu, Lufthansa Airways
Anganwadi Centre—PPP Model
came up with a proposal.
Similar Initiative has been taken up in Gujarat where 47 percent of AWCs
are constructed through public private partnerships.

4.2 Strengthening AWC Monitoring, Karnataka

An intensive monitoring activity of AWCs is being undertaken by Department of Women and

Child Development, Government of Karnataka. Detailed monitoring checklist has been
prepared for validation at each AWC. Team of officials observes merits and demerits of
ICDS service delivery and infrastructure along with assessment of other programmes of the
department. The report has been submitted to Deputy Director in the State, who as a
follow-up action addresses the identified problems in coordination meetings with the line
departments.

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 POTENTIAL GOOD PRACTICES – THE ICDS EXPERIENCE

4.3 Increasing Reach and Coverage in Gujarat and Haryana

To address the needs of socially and

geographically excluded population mostly in the
remote interior areas, Government of Gujarat has
started Mobile Anganwadi Vans to provide
services to the beneficiaries in these areas using
the State’s Budget. In Haryana ‘Bhatta Patshala’
mobile AWCs are operational with the help of
NGOs for providing preschool education to children
of migrant labourers.

Mobile Anganwadi Centre

4.4 Anganwadi entry festival / Campaign in Kerala and Gujarat

In Kerala, May 31 has been declared as Anganwadi admission date. It is observed in all
anganwadis with celebrations. School bags, tiffin box, umbrella, uniform etc. are collected
from the community and given to the newly admitted children.

In Gujarat, with thrust on Education for all and lessen dropout rates from school, every year in
June, a massive drive is conducted wherein all the eligible children are enrolled in their
respective AWCs.

4.5 Kuposhan Mukti Abhiyan, Chhattisgarh

A special campaign to eradicate under-

nutrition is initiated by state government
since 2009 using its State budget. The
campaign emphasises to create
awareness amongst community and
family members on under-nutrition
among children. The severely
undernourished children are identified
and referred to the health system. A
unique feature of the campaign is that
the community adopts severely
undernourished children. For treatment
of severely undernourished, Rs. 800/-
Mashall Rally organised for mass awareness
per beneficiary is earmarked
for medical checkup and medicines and Rs. 1500/- as consultation fees of private
paediatrician.

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 POTENTIAL GOOD PRACTICES – THE ICDS EXPERIENCE

4.6 Joint Cooking Arrangement “Sanjha Chulha”, Madhya Pradesh

ICDS in convergence with Mid-Day Meal

Scheme implements joint supplementary
feeding programme “Sanjha Chulha” for
AWC children. In the programme, two hot
cooked meals i.e. morning snacks and
lunch are prepared with the help of local
SHGs and served at the AWCs.

This allows AWW and AWH to spend more

time with for preschool education activities
as well as for home visits and counselling
for under threes.
Sanjha Chulha

4.7 Geographical Monitoring and Information System (GMIS), Andhra Pradesh

To improve the accountability and programme

effectiveness in ICDS with support of
technology, Andhra Pradesh has initiated
GMIS. This is a unique pilot project where
technology is used up to the Anganwadi level
to track the beneficiary. It is being
implemented with support of CARE in three
districts viz. Hyderabad, Vizianagaram and
Kurnool covering 200 ICDS projects. The
Anganwadi worker enters the beneficiary wise
data in a laptop at sector level using a
customised software, which generates reports Anganwadi Workers using Laptops

for the AWWs such as due list for immunisation, home visit list to vulnerable and at risk families
and any other consolidations that the AWWs requires. The sector level data is uploaded to
the central server where Supervisor and CDPO use the information for tracking the progress
and developing action plans.

4.8 Use of ICT for Daily Monitoring of Supplementary Nutrition, Madhya Pradesh

In one district Shajapur of Madhya Pradesh, the mobile technology has been piloted to provide
real time data from the Anganwadi centre. Toll free numbers are provided to report the AWC
status for the day. After food distribution each AWW sends a report through SMS to respective
supervisor; Supervisors in turn provide the information to CDPO and through the DPO the

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 POTENTIAL GOOD PRACTICES – THE ICDS EXPERIENCE

report is received by the District Collector and the ICDS Director in the State. Details of daily
food distribution are received from all 52 sectors in the district; replication of this model is
underway.

4.9 The Rajmata Jijau Mother-Child Health & Nutrition Mission, Maharashtra

The Mission was constituted by the

Department of Women & Child
Development, Government of Maharashtra
in 2005 with the primary objective of
reducing under-nutrition amongst children
in 0-6 age group. Initially the Mission was
launched to combat under-nutrition in 5
districts of Gadchiroli, Amravati, Nasik,
Thane and Nandurbar. Later, with effect
from 1 April 2006, 10 more districts viz.
Gondia, Nagpur, Chandrapur, Yeotmal,
Dhule, Jalgaon, Ahmed Nagar, Pune,
Nanded and Raigad were included in the Focus on growth Monitoring

scope of the Mission activities.

The first phase was completed in 2010 and the period of Mission was extended for another
five years. The Mission steering Committee is headed by the Chief Minister and the Mission
Implementation & Monitoring Committee works under the Chairmanship of the Minister for
Women & Child Development. Mission Advisory Committee works under the Chairmanship
of the Chief Secretary.

Special focus was given to (a) complete survey and enrollment of all eligible children 0-6
years (b) weighment of all eligible children (0-6 years) i.e. ensuring a weighing efficiency of
100 percent (c) identification of underweight children and provision for treatment and care of
these children (d) Special attention to children below 3 years, (e) emphasis on appropriate
feeding practices of pregnant women and children (f) care of pregnant and lactating women
(g) care of adolescent girls (h) convergence (i) capacity building and (j) monitoring and
assessment.

The Mission ensures provision of facility-based care from Child Development Centres (CDC)
(set up at the PHCs and other health facilities) and community-based approaches established
at Anganwadi Centres (Village Child Development Centres, VCDC).

VCDC functions with support from health and ICDS functionaries, after assessment of the
child. Children who are admitted in VCDC attend sessions for 30 days. During these 30 days

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 POTENTIAL GOOD PRACTICES – THE ICDS EXPERIENCE

three especially designed extra meals are provided to children from the AWCs in the morning
and evening, micronutrient supplementation and antibiotics are also administered under the
supervision of medical officers.

The Mission has now been extended beyond Mother and child care centres for prevention of
under-nutrition in P & L mothers with emphasis on (a) IYCF, (b) proper feeding practices (c)
diarrhoea and deworming (d) Iron and Zinc deficiency.

4.10 The Success Story of Lalitpur, Uttar Pradesh

BRD Medical College, Gorakhpur, UP

conceptualised and implemented the Baby-
Friendly Community Health Initiative’
(BFCHI) project in Lalitpur district. The
project started in November 2006 and
continued up to December 2012 covering
all 6 blocks i.e. Birdha, Jakhaura, Talbehat,
Madawara, Mehrauni and Baar in a phased
manner benefitting 951 ICDS villages. Complementary Feeding

The overall objective of the project was to

test a district-based model for promoting optimal infant and young child feeding with the view
of its scaling up through the ICDS and NRHM programme. The project contributed in improving
the nutritional status of children 0-2 years through optimal Infant Feeding (IYCF), immunisation
of children and improved growth monitoring and promotion.

The project adopted both centre-based

and community-based strategy. At the
cutting edge is a skilled Mother Support
Group (MSG) comprising of AWW,
ASHA, and traditional birth attendant/an
active mother from the village. The
mother support group together with the
existing community groups worked to
promote optimal breastfeeding and
complementary feeding at the household-
level. The trainers at the block level serve
as mentors and guide for the AWW and
Counselling by MSG
well as to mother support group.

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 POTENTIAL GOOD PRACTICES – THE ICDS EXPERIENCE

The MSG members were trained by middle level trainers, especially to inform and counsel
mothers and provide hands-on support for early breastfeeding, correct positioning and
attachment, lactational problems etc.

A total of 951 MSGs in 951 ICDS

villages were formed. Each MSG
consisted of 3 members; as a result
total 2,853 trained MSG members were
available in the whole of Lalitpur.

With the ‘village level counsellors’ having

been close to mothers, Lalitpur has
shown tremendous increase in
breastfeeding rates. The percentage
increase in initiation of breastfeeding
within one hour of birth has gone up from
10.6 per cent (2006) to 62 per cent Counselling by MSG
(2011).

Exclusive breastfeeding for the first six months has gone up from 6.6 per cent (2006) to 60
per cent (2011). Timely and appropriate complementary feeding during 6-8 months has gone
up from 53.8 per cent (2006) to 95 per cent (2011). These are much above the average of
Uttar Pradesh State. This project has demonstrated convergence at village level and a
heightened motivation of trainers and village level counsellors to prevent malnutrition and
morbidity associated with faulty infant and young child feeding practices through skilled peer
counselling.

4.11 Multisectoral approach in VHND, Tripura

Absence of data, incidences of child deaths and difficult to reach area prompted the district
administration to adopt a multisectoral approach in delivering health and nutrition services to
the remote tribal village of Unakoti. Coordination was established with departments of health,
ICDS, social welfare, drinking water and sanitation, rural development, panchayat and school
education.

The activities are village-based and 3-4 habitations (AWCs) come together for delivering
services on this day.

The funds available with various developmental schemes including ICDS, NRHM IEC and
funds of other schemes are pooled together to organise VHND. The CDPO, MO, Deputy
Inspector of Schools and sub divisional officers meet quarterly and decide the draft schedule

48
 POTENTIAL GOOD PRACTICES – THE ICDS EXPERIENCE

of the VHND which is approved by block level PRI body, Panchayat Samiti. VHND is organised
by involving frontline workers of different sectors - AWW, ICDS Supervisor, MPW, ASHA,
pump operator of drinking water department, gram pradhan, field facilitator, livelihood facilitator,
youth volunteers, school head master, teacher of mid-day meal, mid-day meal cook, staff of
disaster management body, district disability rehabilitation centre, awareness volunteers of
district administration etc. Detailed role and responsibilities of these functionaries has been
developed for ensuring proper coordination. Specific modules have been developed to train
functionaries of line departments for organising various activities.

Activities organised on this day include awareness generation on 14 major illnesses, weighing
of children, health check-up and small quiz for mothers and children on primary health issues
and immunisation. All women, children and adolescent girls and the headmaster along with
students up to class 10 attend the VHND. Programmes like blindness control, malaria
eradication, tuberculosis control, AIDS prevention, disability rehabilitation, first aid during
disasters are also delivered. The school health programme has also been merged with VHND
and the head master has been trained to generate awareness on health issues amongst
children. In order to seek larger participation of the community, cultural activities like folk
dance, group songs, baby shows, sports and street drama are organised. IEC material in
local language has been developed for information dissemination in the villages. Youth teams
comprising boys and girls of 18 to 22 years have been trained to mobilise community. Overall
monitoring is done by village panchayat. Reporting registers with duplicate perforated sheets
have been supplied for data collection and for entering the same on the state web portal. The
register is countersigned by gram pradhan and representatives of various other departments.
Validation of the data is done by health department. The data is being put on public portal for
larger dissemination. Since 2010, almost 2140 VHNDs have been organised in the district
of Unakoti with the participation from 3,28,947 adults
and 1,34,700 children. A total of 30,685 children have
been immunised and 61,619 children weighed; also,
1,293 under-weight children have been identified and
7,019 infants administered Vitamin-A supplementation
and 671 ANCs have been conducted.

4.12 Nutrition-cum-Day Care Centres (NDCC),

Andhra Pradesh

Community-assisted and supervised feeding centres

called NDCCs are operated in Andhra Pradesh. These
centres are managed by Village organisations (VOs)
who are provided one time grant of Rs 2,50,000 under
Indira Kranti Patham Initiatives towards providing
balanced diet (3 meals per day) to the pregnant women

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 POTENTIAL GOOD PRACTICES – THE ICDS EXPERIENCE

and children under two belonging to beneficiary families (those enrolled as SHG members).
The NDCC is managed by a team comprising of one health activist, two health sub committees
members and one cook. NHED sessions are held for pregnant lactating women and children
below 2 years. The cook is an SHG member and the meals are supplied by SHGs at Rs 30
per day per person.

Each VO leases 2-3 acres of land for vegetable gardening and revenue generated is used
for running NDCCs. These centres help in promotion of use of green leafy vegetables and
millets. Each VO and NDCC is responsible for Shram Shakti Sanghas (P&L women and
women with under 2 children) at NDCCs to get 100 days of work under EGS category. The
programme envisages establishing convergence with ICDS, Health and PRI Departments.

Convergence with ICDS is attained by

• Supply of ration to VOs from AWCs for beneficiaries enrolled in NDCC

• Support from AWWs for NHED sessions

• AWH may provide support as cook

Health and nutrition intervention with emphasis on Community Resource Persons, screening
camps, NDCCs and MCH education sessions in NDCCs has been useful in reducing under-
nutrition and improving low birth weight.

4.13 Balintadarshanam, Andhra Pradesh

In the State of Andhra

Pradesh, AWW mobilises
the ANM, ASHA and female
PRI members to visit the
households of lactating
mothers so as to explain
them about neonatal care,
post-natal care and nutrition
within 7 days of delivery.
Further in order to ensure
colostrum feeding within one
hour of birth and to ensure
NHED Sessions at VHND
exclusive breast feeding for
six months and introduction
of complementary feeding immediately after completion of 6th month, Cradle Ceremony and
Annaprasana events are also being organised.

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 POTENTIAL GOOD PRACTICES – THE ICDS EXPERIENCE

4.14 Gas Chullah Connections, Gujarat

Use of LPG at AWC.

In order to provide freshly prepared supplementary nutrition every day at the AWC and in
order to save the AWW and AWH from harmful exposure of the smoke from ‘Chulha’, the
States of Andhra Pradesh, Gujarat and Haryana are providing Gas Connection from the flexi
funds. In the state of Gujarat, Stove and an ‘Idli’ cooker have also been provided at each
AWC.

51
 SECTION - E

INTEGRATED
APPROACHES IN EARLY
CHILDHOOD CARE
PROCESSES AND
LESSONS LEARNT
 POTENTIAL GOOD PRACTICES – THE ICDS EXPERIENCE

Integrated Approaches Assisted by

5 Development Partners
The persistent high levels of under-nutrition amongst children and women in India led to the
thought that food alone cannot resolve the problem; a constellation of services and methods
need to be put in place which would involve the community, policy makers and implementers
and empower those at the family and grass root level.

By mid-2000 there was increased attention on Early Childhood Care for survival growth and
development of children. This was a turning point and Development Partners like World Bank,
Care and UNICEF were prompted to pilot some of best integrated approaches for reduction
in under-nutrition through ICDS. Comprehensive strategies were designed in partnership
with State Governments.

All these programmes had similar aims, that is, reduction in under-nutrition rates and
contributing to decreased mortality and morbidity in children, objectives very similar to that of
ICDS. Each of these programmes brought in a set of basic services, and additional
interventions which included mass mobilisation, empowerment through capacity building,
micro level planning, behavioural change, use of monitoring tools and action at the community
level. ICDS was a ready to use platform for these pilots. Further each of these programmes
was guided by a set of monitorable indicators specific to the need of the community.

These programmes have been evaluated, several lessons have emerged and the impact
has been well studied, however the details of scaling up of these programmes have not been
worked out.

The purpose of including this section on comparative analysis of the Community-based

approaches is to evoke a response towards possible scale up of most effective components
of these models through ICDS.

5.1 The Innovative Approaches

The innovative approaches enlisted are Dular strategy, Positive Deviance (PD), Anchal Se
Aangan Tak (ASAT), Integrated Nutrition and Health Programme (INHP) and Tamil Nadu
Integrated Nutrition Programme (TINP). Efforts are made to provide process followed against
each activity within the approach. The note reviews the key activities, process and the impact
of these approaches.

5.1.1 The Dular Strategy

The Dular strategy is a nutrition initiative initiated by UNICEF India in collaboration with the
States of Bihar and Jharkhand. Designed to complement the government’s Integrated Child

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 POTENTIAL GOOD PRACTICES – THE ICDS EXPERIENCE

Development Services (ICDS) and build upon its infrastructure, one of the major goals of the
Dular programme is to capitalise and develop community resources at the grassroots level.
The emphasis of the Dular programme is on establishing a community-based tracking system
of the health status of women and of children 0 to 36 months of age by neighbourhood-based
local resource persons (LRPs). The main objectives of the Dular programme include increased
prenatal attendance, improvement in breastfeeding and colostrum, safe delivery, improved
nutritional practices and decreased under-nutrition. The strategy promotes simple low or even
no-cost home-based interventions and focuses on enhancing the capacity of caregivers to
nurture a person from birth through early childhood and adolescence to adulthood. Since
January 2007, ‘Dular’ strategy has become a part of the Bihar Government’s ICDS programme
when it was expanded from four pilot districts to all 38 districts state-wide.

Table 5: Key programme Inputs - The Dular Strategy

Key Activities Process

Village contact – This event consists of 2 days of training and advocacy during
drive (VCD) which the objectives of the strategy are discussed with
community and information is gathered regarding local
beliefs and practices related to women. This information is
used to plan project activities appropriate to local conditions
that are maintained over a consistent period.
– The VCD uses participatory methods and demonstrations to
enhance awareness and participation of the community.

Local Resource – LRPs identified during the village contact drive collectively
Persons (LRPs) to form a local resource group (LRGs), which meets weekly with
assist the AWW at the AWW to review progress.
the village level – Criteria for LRP selection are that she should be a resident
of village, vocal, educated if possible and active.
– LRGs assist AWW with distribution of THR, identification and
enrolment of beneficiaries and creating awareness within the
community through counselling and household visits and
prove instrumental in identifying households with pregnant
and lactating women.
– Training of LRPs and functionaries is held at Block level
using specific training tools and modules.
– The LRPs participate in the “Mahila Mandal” meeting.

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 POTENTIAL GOOD PRACTICES – THE ICDS EXPERIENCE

Key Activities Process

Household – LRPs provide counselling to allotted households on Dular

counselling on various indicators- Breastfeeding (colostrum feeding within 1 hour of
issues related to birth, initiation of breastfeeding, exclusive breastfeeding for
health and nutrition six months, complementary feeding from 7th month onwards
along with continued breastfeeding till child reaches 2;
institutional delivery; IFA consumption; consumption of
iodised salt; motivate the families for weighing and
immunisation.
– Dular kit consisting of 10 flash cards is used by LRPs and
AWW to counsel households and for training purposes.
– Dular folder depicting positive behaviours is used in
counselling.
– LRGs spend considerable time talking to women in an effort
to educate them on new practices.
– An adolescent card is provided to the adolescent girls who
tracks compliance of IFA tablet and provides information on
key health nutrition and hygiene issues.

Regular weighing of – Regular weighing of children is done in AWC by AWW with

children and its support of LRGs, who identify and mobilise caregivers for
monitoring weighment of their children.
– At household level a dular card is provided to the caregivers
to monitor progress of their children.

Assessment of – A Task Force at the state level assesses and develops

capacity and communication and training needs based on block and
communication district review and report from field.
needs within the
community

District Mobile – The members of DMMTT are CDPOs and Supervisors.

Monitoring Training – Orientation of Mobile Monitoring Training Team (DMMTT) in
Team (DMMTT) to batches by the District Dular Team.
monitor progress – Monthly monitoring of centres conducted by each DMMTT
and provide on the member using MPR formats.
job guidance to
village teams

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 POTENTIAL GOOD PRACTICES – THE ICDS EXPERIENCE

Key Activities Process

District Support – Issues arising from the Block Coordination committee

Team (DST) to taken up in monthly review meeting of the District Support
improve coordination Team and block level officials under the chairmanship of
between sectors, District Collector convened by District Programme Officer.
review overall
progress, and ensure
effective
implementation
across the district

Dular Cell to monitor – Dular MIS is integrated in the ICDS MIS.– MIS data utilised to
progress of Dular and monitor the quality improvement of ICDS.
link it to overall quality
improvement of ICDS

5.1.2. Positive Deviance Approach

The Positive Deviance Approach is based on the notion that even in poorest communities
there are children with better nutritional status. These children are referred to as Positive
Deviants (PD). The approach involves referring to Positive Deviants, in counselling parents
of undernourished children for promoting positive behaviour amongst the families of under
nourished children. The approach was pioneered for reduction of under-nutrition through ICDS
in West Bengal the programme, and given a local name Kano Parbo Na (We Can Do It).
Positive outcomes from pilot districts in West Bengal led to upscaling in West Bengal and its
replication in Orissa. The state of Orissa adopted Positive Deviance Approach as Ami Bhi
Paribhu (I Can Also Do It). Both the states have been able to reduce under-nutrition substantially
and promote sustainable care practices at the family level. It enabled families to break the
dependence on supplementary nutrition programme by identifying cheap, locally available
nutritious food which only some families (PD) used. Under this initiative, behavioural change
is emphasised through participatory learning and hands-on training of caregivers on how to
prepare and feed high protein and energy meals to their children. It is characterised by 12-
day regime followed by an 18-day home practice. A gain of 200-400 gm is envisaged in 12
days. Further, community mobilisation, an in-built component of the programme, has resulted
in overwhelming positive response from communities in organising and participating in various

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 POTENTIAL GOOD PRACTICES – THE ICDS EXPERIENCE

collective and creative activities at village level and emergence of motivators and champions
at the grassroots level. It has also significantly strengthening linkages between key
stakeholders (the community, ICDS, the Panchayat and MOH ICDS).

Table 6: Key Programme Inputs- Positive Deviance Approach

Key Activities Process

Preparatory activities – A survey of the children in the age of group of 0 to 3 years is

and planning carried out in the village. The community members along with
the AWW and supervisor participate in the survey.
– During the survey, all children are weighed to identify healthy
(positively deviant) and undernourished children. The survey
forms the basis for selection of the village / area for the
project.
– A Village Social Map is prepared indicating the homes of
positively deviant and malnourished children in the village.
– The Community Growth Chart is maintained depicting the
nutritional status of children.

Orientation of Opinion – The opinion leaders are oriented on the nutritional status of
Leaders children in their village, based on the Survey results.
– A village committee is formed to oversee the programme
implementation

Capacity Building – Joint training on Positive Deviance Approach to Service

Providers (CDPOs, LHVs, Supervisors, AWW, ANM, ASHA)
and PRIs.

Community – The gravity/scale of the problem is advocated in the

orientation and community.
sensitisation – This process is done using social map and community

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 POTENTIAL GOOD PRACTICES – THE ICDS EXPERIENCE

Key Activities Process

growth chart.
– This advocacy leads to community decisions to tackle the
problem.

Discovering Positive – The uncommon successful practices of the positive deviant

deviant behaviour families is discovered through positive deviant inquiry (PDI)
tool (a simple questionnaire).
– Focus group discussion (FGD) is conducted to identify
current common practices in the village.

Analysis of PDI and – The AWWs and supervisors invite the community to discover
FGD with Community the desired practices that contribute to the better growth and
development of the child, decisions to conduct Nutrition
Counselling and Care Sessions (NCCS) are taken herein.

Special interventions – The Nutrition Counselling and Childcare Sessions conducted

for severe and for 12 days of each month mostly at the Anganwadi centre or
moderate any other place in the village as per caregivers’ convenience.
Underweight children – The child is weighed on the first day and again on 12th day.
– Mothers/ caregivers learn care practice (feeding, hygiene,
health and psychosocial practices) through learning by doing
technique facilitated by AWWs and Positive deviant mothers.
– Care givers learn to cook nutritious meal for the child.
– The foods given are from SNP, green leafy and yellow
vegetables, egg, peanuts, soyabeans etc. are contributed by
caregivers and community.
– Care givers feed the child on spot.
– NHEDs are held emphasising about good feeding practices,
health, hygiene and psycho-social care of the children.
– On the 12th day the child is weighed again, the child gains
200-400 gm in these 12 days. Children failing to gain weight
are referred.

Monitoring and – Mothers/ family use Mother Child Protection Card to monitor
follow-up the growth of the child.
– After 12 days NCCS, mothers and caregivers follow the
cooking methods and feeding, health, hygiene and
psychosocial practices for the remaining 18 days of the
month at their home.

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 POTENTIAL GOOD PRACTICES – THE ICDS EXPERIENCE

Key Activities Process

– The AWWs and supervisors monitor the follow-up of NCCS

through home visits and provide interpersonal counselling.
– Children come back for a new cycle of Nutrition and
Childcare Session the following month. Children continue till
they graduate to Normal.

5.1.3 Anchal Se Angan Tak (ASAT)

Rajasthan State Plan of action guided by ‘first call for children’ has been prepared to give
thrust and impart sense of emergency in enhancing status of the girl child so that there is
discernible reversal in the deteriorating sex ratio, increase in age of marriage and better
opportunities for her education and development. In keeping with requirement ASAT was
conceptualised.

ASAT was an integrated early child development (IECD) programme, supported by UNICEF
and Implemented in seven districts of Rajasthan. It aimed at improving child survival, growth
and development. The rationale was to improve the nutritional and health status of children
below 3 years, pregnant and nursing women, and adolescent girls through behavioural change
in care practices at the family and community level. The life cycle approach was adopted to
improve the health, nutrition and psychosocial status of children with special focus on children
under 3 years of age, pregnant and nursing mothers, and adolescent girls. The strategies
included advocacy, community mobilisation and participation, capacity building of functionaries,
caregivers and community members. Joint training programmes were conducted for all the
anganwadi workers (AWWs) and auxiliary nurse-midwives (ANMs) of the seven districts.
Gram Sampark Samoohs (GSSs), each comprising 18-25 members had been organised in
the villages and urban slums. The GSS was a link between the community and the AWW and
provided assistance to the AWW in conducting the activities of ICDS programme. Kishori
Balika Mandals and Self-Help Groups have been organised to impart such skills to women
and girls that can later be utilised for income generating activities. Family-retained ‘Mamta
card’ was used for tracking health and nutrition status of the children and pregnant mothers; it
was also used for educating the mothers and family on child development and age appropriate
feeding.

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 POTENTIAL GOOD PRACTICES – THE ICDS EXPERIENCE

Table 7: Key Programme Inputs- Anchal Se Angan Tak (ASAT)

Key Activities Process

Community – Formation of Gram Sampark Samoohs (GSS) per AWC.

mobilisation and – AGSS comprised of 18-25 members. Each GSS member
participation was responsible for 15-20 households at village level. They
reviewed the progress of activities and prepared plan of
activities for next month with the anganwadi worker (AWW),
the anganwadi helper (AWH), the local teacher and the
representatives of PRI in the village.
– GSS coordinated the activities, which included registration of
children and pregnant women, mapping of the area/village to
identify and focus on households with malnourished/sick
children, demonstrations for preparing complementary food
for young children, preparation of ORS solution, weighing
children below 2 years of age, growth promotion and use of
media/puppet shows to impart knowledge on IECD.
– The GSS provides information about on going and
forthcoming events.
– Competitions such as mehndi, acting and poems were
conducted to stimulate cohort learning and participation.
– Self-learning process introduced through community-based
organisation as mahila mandals and Kishori balika mandals
in their respective meetings.

Household – The home visits and home-based counselling of women and

counselling on families was conducted by AWW, AWH and GSS with use
various issues of IEC.
related to health
and nutrition

Mother and Child – Held at the AWC and facilitated by the ANM and AWW with
Health and Nutrition assistance from the Sahyogini.
Day (MCHN)

Fixed weighing and – Day was fixed one week prior to the MCHN day.
counselling day – Held at the AWC and facilitated by the ANM and AWW with
assistance from the Sahyogini.

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 POTENTIAL GOOD PRACTICES – THE ICDS EXPERIENCE

Key Activities Process

Advocacy – Use of folk media to communicate mother and child care.

– Mass media such as All India Radio (AIR) and Doordarshan
were used to communicate messages on health and nutrition
issues.
– Use of local dialect.

Training and – District and Block Level functionaries capacitated on

Capacity Building importance and modalities of implementing IFA
supplementation, safe delivery and self-hygiene.
– PRIs and SHGs trained on health nutrition psychosocial
issues and monitoring indicators of child development.
– Primary School teachers trained on importance and methods
of providing IFA supplementation to school going adolescent
girls.
– GSS conducted capacity building of the target families and
communicating the nutrition and health messages of the
Mamta cards.

Empowerment of – IEC material had been developed and animators, AWWs and
women and anganwadi helpers were trained to use this material for
adolescent girls counselling women and care givers.
– Adolescent girls were also trained.

5.1.4 Integrated Nutrition and Health Programme (INHP)

The initiative focussed on what mothers can do to safeguard their families’ health, such as
practicing good hygiene and nutrition. The programme augmented support to ICDS and RCH
programmes with additional interventions to support improvements in maternal and child
health and nutrition services, behaviours and outcomes, such as promotion of antenatal care
and neonatal care, breastfeeding, complementary feeding and child nutrition, family planning,
nutrition and health education. INHP-II was built upon a three-decades-long relationship between
CARE-India and the ICDS programme, and was designed to address child health and nutrition
at scale, with the objectives of helping reduce malnutrition and mortality in children. It adopted
a two-track approach – supporting service providers to improve the quality and coverage of
MCHN services and systems and engaging communities to support better infant feeding and
caring practices and sustain activities for improved maternal and child health and survival.

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 POTENTIAL GOOD PRACTICES – THE ICDS EXPERIENCE

The organisational structure of INHP-II was designed to provide opportunities for engaging
the ICDS and RCH programme at sub-district, district, state and national levels. Beginning
with a set of best practices from INHP-I, the project used a demonstration-replication approach.
This involved local partnerships with NGOs for demonstrating the implementation of these
best practices, which were then taken up by ICDS and RCH programme functionaries for
similar implementation in the rest of the project area.

The implementation was facilitated by small programme teams of CARE, located at the district,
state and national levels, and working closely with the functionaries of the ICDS programme
and the programme of the MoHFW, and with a range of partners, including local NGOs and
Community-Based Organisations (CBOs). The project worked through 7,700 anganwadi
centres in eight states: West Bengal, Orissa, Bihar, Uttar Pradesh, Rajasthan, Andhra Pradesh,
Chhattisgarh and Madhya Pradesh.

Table 8: Key Programme Inputs- Integrated Nutrition and Health Programme

Key Activities Process

Antenatal Care – Focus on improving birth outcomes through existing

interventions like immunisation, IFA supplementation,
monitoring of weight gain and abdominal check-up

Nutrition Essentials – Package of critical nutrition interventions like Health and

nutrition education, IPC, growth monitoring, promotion of
infant and young child feeding
– Education

Immunisation – Fixed Day NHED was initiated to strengthen immunisation

and tracking mechanism

Food supplements – Providing the in-kind commodity i.e., corn-soya blend (CSB)
and refined vegetable oil (RVO)

Involvement of – Change agents selected from the community were

Change Agents / responsible for monitoring and mobilising 15 – 25
Reproductive health households with the support of AWW
Change agents

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 POTENTIAL GOOD PRACTICES – THE ICDS EXPERIENCE

Key Activities Process

Community-Based – Locally designed individual self-monitoring tools and use of

Monitoring System social mapping to track caring practices and service
(CBMS) utilisation

Block level resource – A process of programme review and action by functionaries

mapping (BLRM) at block level using the social map

Nutrition and Health – Every month fixed day where take home rations are
Day (NHD) distributed and ANM visited the AWC to offer health services

Demonstration sites – In partnership with local NGOs, model sites called

demonstration sites in 10% AWCs were created where
programme implementation could be demonstrated and then
replicated in other sites

Strengthening Supply – Streamlining supplies/distribution of Supplementary nutrition

Chain Management

Community outreach – Efforts at involving communities including change agents/

and mobilisation CBOs/ PRIs in monitoring and supporting behaviour change
activities

Capacity Building – Capacity building had three components – technical content,

process skills and motivation. Besides formal training, it
included non-training inputs such as cross-visits, joint
programme reviews, supportive supervision and on-going
capacity building through review meetings.
– All INHP staff, system functionaries, NGO functionaries
including government staff participated in structured training
programmes.
– On-going learning mechanism was followed and informal
training was imparted at sector meetings.

Behavioural Change – Formative research conducted in the initial across states,

Communication helped identify barriers in different socio-cultural contexts,
this was useful in the development of culturally appropriate
communication for different contexts.
– Efforts were made to work with other stakeholders to get
consensus on the key messages and avoid any duplication.

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 POTENTIAL GOOD PRACTICES – THE ICDS EXPERIENCE

Key Activities Process

– Use of multiple channels of communication, including mainly,

interpersonal communication.

Programme – A brief set of indicators was reported monthly from every

monitoring AWC.
– Rapid assessments conducted in panel of districts.
– HMIS collated at central level.

Addressing gender – Disaggregated data analysis.

and social – Improved inclusion and tracking systems.
inequities – At the community level, the programme also integrated
gender and equity dimensions into capacity building, BCC
activities and the best practices.

Focussed – Simple tools and checklists were drawn up for supervisors,

Supervision and again using early versions already in use elsewhere in the
Home Visits on programme.
Critical Life Cycle – Home visits diary maintained by AWW.
Interventions

Synergising Efforts – The NGO staff supported the sector supervisor as well as the
at the Sector Level CDPO and coordinated with district team in conducting
effective sector meetings and field visits until they learnt to
do it on their own.

5.1.5. Tamil Nadu Integrated Nutrition Programme (TINP)

The programme was implemented in Tamil Nadu in two phases.

Phase I

The overall goal of the project was to improve the nutritional and health status of preschool
children, primarily those 6-36 months old and pregnant and nursing women. For this purpose,
a package of services was provided: nutrition education, primary health care, supplementary
on-site feeding of children who were severely undernourished or whose growth was found to
be faltering, education for diarrhoea management, administration of vitamin A, periodic
deworming and supplementary feeding of a limited number of women. A principal characteristic
of this project was the use of growth monitoring through monthly weighing of all children 6-36
months old to target delivery of these nutrition and health services to needy children and to

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 POTENTIAL GOOD PRACTICES – THE ICDS EXPERIENCE

serve as an educational device for mothers. Indeed, this project was the first large-scale use
of growth monitoring for this purpose. Project funds were utilised, among other things, to
establish, equip and operate some 9,000 Community Nutrition Centres (CNCs) and 2,000
new health sub centres in 173 of Tamil Nadu’s 373 rural blocks (an administrative unit covering
a population of about 100,000).

Phase-II

Phase-II was designed to cover, in a phased manner, 316 of the total 385 rural blocks in Tamil
Nadu, with an estimated total population of 32.8 million. The target group had been extended
to encompass young children from birth until six years of age (as against 6-36 month old
children in Phase-I). Further, in recognition of the duplication (geographic and age-group) of
the services of Phase-I and the Noon-Meal Programme (NMP), Phase-II merged Phase and
NMP centres, to promote complementarity. Phase-II centres were opened in select non-Phase-
I areas, while existing Phase-I centres were simultaneously converted to Phase-II centres.
TINP blocks were converted to ICDS depending on governmental allocations for ICDS. A
total of 9194 Community Nutrition Centres functioned under Phase-II, covering 98 new blocks,
over and above the 177 Phase-I blocks. An additional 5257 centres were opened in the new
phases. An IDA loan of US $ 95.8 million spread over an eight-year project implementation
period (1991-98) was approved for the second Tamil Nadu Nutrition Project. The specific
objectives of Phase-II include:

• Reduction of severe malnutrition among 0-36 month old children by 50% in new project
areas, and 25% in Phase-I areas;
• Increasing the proportion of children classified as ‘normal’ by 50% in new and 35% in
Phase-I areas;
• Contribute to a reduction in infant mortality to 55 per thousand live births;
• Contribute to a 50% reduction in incidence of low birth weights.

The new Phase-II design included preschool education, and was less selective in identifying
beneficiaries for supplementary feeding. Both features bring the TINP design closer to that of
the ICDS. Further, the field-worker: supervisor ratio has also been reduced (from 10:1 in
Phase-I to 15:1 in Phase-II) making it akin to the 25:1 ratio followed in the ICDS. There are
some indications that much of the uniqueness of TINP design is being lost in this apparent
shift towards the ICDS.

Worker training seemed to be lagging behind TINP-II phasing-in, so that in many of the newer
project areas, the essence of TINP-I is missing. Without the planned training, there were
several anomalies relating to the duties of the NMP worker and the TINP worker who have
simply been instructed to function from the centre. The two workers were not clear about the
demarcation of duties, and/or the changes in the objectives or design of the TINP.

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 POTENTIAL GOOD PRACTICES – THE ICDS EXPERIENCE

Table 9: Key Programme Inputs- Phase I & Phase II

Key Activities Process

TINP I

Supplementary – Supplementary nutrition was provided to grade 3 and 4 and

nutrition those children faltering for 3 consecutive months.
– All children in grade 3 and 4 fed double ration (Selective
targeting).

Nutrition education – For 10 Community Nutrition Worker (CNW) there was 1

Community Nutrition Supervisor (CNS) and for 4-7 CNS
there was 1 Block community nutrition Instructor.
– CNS and CNW had two months pre-service training.

Growth Monitoring – Mother linked child health card used record child health
status.
– Each month, CNWs generated a set of management
information which was publicly displayed for their own and
the community’s use on a blackboard on the outside wall of
the CNC.
– Community growth charts also displayed on the CNC wall.

TINP II

Programme design − Emphasis on service delivery, fixed day service.

− Emphasis on coordination between health and nutrition
sectors.
− Training plan modified.

Target Group − 0-60 months, increased outreach and coverage.

Amalgamation of − Combining TINP and NMC where both existed.

TINP programme − Addition of a Community nutrition worker in NMP centres
with the State’s Noon (two-worker model).
Meal Programme

Expansion of − Physical investment, developing new centres in un-served

Community nutrition areas.
centre network

Communication − Emphasis on the communications component, with special

strategy attention to developing and operationalising a specific
communications strategy.

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 POTENTIAL GOOD PRACTICES – THE ICDS EXPERIENCE

5.2. Lessons Learnt from integrated packages

The processes followed in each initiative suggest certain common factors elemental in success
of the programme. The factors distilled from the note relate to mostly programme specific
factors. These factors had been inbuilt in programme design, content and its management in
differential ways in each of the integrated initiatives. Obviously not every factor is required for
a programme or project to work but those below serve as a useful checklist of desired
characteristics for a community-based initiative. An exhaustive list of factor wise processes
is provided in Annex A.

5.2.1. Process leading to Programme Development

• Conducive policy environment - Each of the initiatives was supported by the ICDS
mechanisms in village, block, district and state level.

• Assessing and analysing nutrition situation - Most of the initiatives conducted social
mapping to assess and analyse child and mother health situation in the intervention
areas. Besides this Positive Deviance conducted survey of all the children and ASAT
followed triple A process of assessment, analysis and action.

• Selection of an entry point – Most of the initiatives are addressing priority problems such
as strengthening ICDS delivery and providing education on care of mother and child
health.

5.2.2. Programme Design and Content

• Growth monitoring and promotion - It had been one of the key component of all the
initiatives. Dular, ASAT, INHP, and TINP promoted facility-based growth monitoring and
promotion in VHNDs whereas Positive Deviance facilitated community-based growth
monitoring and promotion in NCCS. The GMP was linked with adequate counselling
and feedback to the caregivers and actions. In PD a community-based feeding is
conducted in response to information collected whereas in other initiatives-facility based
action is upheld.

• Nutrition Education – Nutrition education is provided in all the initiatives by field level
functionaries mostly through household counselling sessions and also during NCCS in
Positive Deviance.

• Adopting Inter-sectoral approach – In all the initiatives health-related interventions such

as immunisation, promotion of institutional delivery, IFA supplementation was quite
apparent.

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 POTENTIAL GOOD PRACTICES – THE ICDS EXPERIENCE

• Advocacy – In all the initiatives local groups/change agents/ community nutrition worker
in TINP were responsible for advocating the programme strategies related to health and
nutrition within the community.

• Improving care of women and children – More emphasis was given on care of children.
Care of mothers was limited to facility-based ANC and PNC at AWC or health centres.

• Capacity Development and Training – In all the initiatives training was one of the key
components. Training was conducted for all stakeholders at all levels using participatory
methodologies. In INHP (later phases) training was done in an informal environment as
Sector level meetings.

5.2.3 Programme Management and Implementation

• Community involvement – Community involvement was sought in problem identification,

planning and implementation in all the initiatives through tools such as social mapping,
resource mapping, survey, and community growth charts etc.

• Social Cohesion – Community-based groups suchas LRGs/ Gram sampark samuhs/

were formed for the initiatives in the intervention areas.

• Collaboration – These initiatives were run in collaboration with the ICDS delivery systems.

• Staffing and their remuneration – At village level except for the AWW and CNW all other
persons involved were unpaid volunteers who were remunerated for travel out of the
village for programme purposes. These personnel were provided trainings to function at
the community level.

• Information sharing – This was facilitated vertically through group meetings and horizontally
through passing out of information in prescribed templates as well as sector level
meetings.

5.2.4. Sustainability

Positive Deviance demonstrated strong sustainable mechanisms involving community and

SHGs respectively in identifying, analysing, and devising plan of action at the local level.

5.2.5. Scaling Up

Positive deviance is one amongst all the initiatives that can be scaled up in short time span
as minimal risks adhering to it.

5.2.6. Impact on under-nutrition

As cited in Annex B, except in INHP, the initiatives reported statistically significant decline in
weight for age, height for age and weight for height.

70
 Comparison of Common Features and Characteristics of Integrated Approaches

Characteristics Dular Positive Deviance ASAT INHP TINP

1. Contextual Factors

Policy environment Universalised ICDS scheme for all children under 6 and P& L mothers

Assessment and Training and Village survey and ‘Triple A’ process Community-based Mother-linked child
Analysing nutrition advocacy during Weighment of all followed by Gram monitoring health cards
situation Village Contact children, Analysis Sampark Samuh systems, Block
Drives of nutritional Status level resource
of children through mapping
Triple A approach
Analysis of positive
deviant behaviours
and common
practices

Selection of an Entry Feeding Feeding practices, IFA supplemen- Immunisation, Supplementary

point behaviours, emphasis on health tation, safe food nutrition to target
deliveries, hygiene and delivery, personal supplements children, nutrition
consumption of psychosocial care hygiene, health, education, growth
IFA and Iodised of children nutrition and monitoring
salt, weighing psychosocial care
and
Immunisation
POTENTIAL GOOD PRACTICES – THE ICDS EXPERIENCE

71
 Characteristics Dular Positive Deviance ASAT INHP TINP

72
2. Programmatic Factors

Growth monitoring Regular weighing Growth Monitoring is On MCHN day During Fixed Done at NHDs
and promotion of children done the basis of the children are NHDs Mother-linked child
in AWC by AWW approach. Weight weighed. It is held health card used
with support of gain is monitored at the AWC and record child health
LRGs, who in every session. facilitated by the status
identify and Mother Child ANM and AWW Each month, CNWs
mobilise Protection Card with assistance generated a set of
caregivers for used Community from the management
weighment of Growth Charts Sahyogini. information which was
their children. used to display publicly displayed for
At household nutritional status their own and the
level a dular card of children. community’s use on a
is provided to blackboard on the
the caregivers outside wall of the
to monitor CNC
progress of Community growth
their children. charts also displayed
on the CNC wall

Nutrition education LRPs provide The Nutrition Home visits and Nutrition Education At the centre level the
counselling to Counselling and home-based given on FNHD. Community nutrition
allotted HHs on Childcare Sessions counselling of AWW and training sessions at
POTENTIAL GOOD PRACTICES – THE ICDS EXPERIENCE

dular indicators. conducted for 12 women and change agents the centre or SHG
Dular kit days Learning by families conducted responsible for it level with the support
consisting of 10 doing technique is by AWW, AWH and of volunteers from
 Characteristics Dular Positive Deviance ASAT INHP TINP

flash cards was used. Discussions LRGs with use among the SHGs and
used by LRPs are held about good of IEC. CNWs.
and AWW to feeding practices,
counsel emphasis also given
households on health, hygiene
Dular folder and psycho-social
depicting positive care of the children.
behaviours was
used in
counselling.

Advocacy In Village The opinion leaders Use of folk media In partnership with None
Contact Drives oriented on and local dialect local NGOs
nutritional status of to communicate developed
children in their mother and child demonstration
village based on care. sites in 10%
complete weighment. Mass media such AWCs where
The scale of the as All India Radio programme
problem is (AIR) and implementation
advocated in the Doordarshan was could be
community using used to demonstrated
social map and communicate and then
community messages on replicated in other
growth chart. health and nutrition sites.
POTENTIAL GOOD PRACTICES – THE ICDS EXPERIENCE

issues. First few months

in a handful of
sites to give

73
 Characteristics Dular Positive Deviance ASAT INHP TINP

74
field teams hands
on learning
opportunities.

Improving care for Emphasis on Care of under Care of children Counselling by Care of selective
women and children breastfeeding, nourished children through weighing, AWW and care children by providing
institutional through counselling demonstration of of women and double ration. Care of
delivery, on improved care complementary Change agents. all children through
consumption of practices- feeding feeding and growth monitoring and
IFA and iodised health, hygiene counselling Care Promotion.
salt, weighment and psychosocial. of women through
and counselling and
immunisation training of
adolescent girls.

Capacity development Systematic Joint training to District and Block Capacity building Institutional training of
training sessions Service Providers Level functionaries had three village workers and
with specific (CDPOs, LHVs, capacitated on components – job training by
training tools and Supervisors, importance and technical content, Community Nutrition
modules used AWW ANM, modalities of IFA process skills Instructor
to train all ASHA) and PRIs supplementation, and motivation.
functionaries and Training of local safe delivery and Besides formal
LRPs at Block groups and self-hygiene. training, it included
level committees PRIs and SHGs non-training
POTENTIAL GOOD PRACTICES – THE ICDS EXPERIENCE

trained on health, inputs such as

nutrition, cross-visits, joint
psychosocial programme
 Characteristics Dular Positive Deviance ASAT INHP TINP

issues and reviews,

monitoring supportive
indicators of Child supervision and
development. on-going capacity
Primary School building through
teachers trained review/sector
on importance meetings
and methods of All INHP staff,
providing IFA system
supplementation functionaries,
to school going NGO
adolescent girls. functionaries
GSS conducted including
capacity building government staff
of the target participated in
families and structured training
communicating the programmes
nutrition & health
messages of the
Mamta cards

Convergence and With Health With Health and With Health With Health With Health
Intersectoral approach PRIs
POTENTIAL GOOD PRACTICES – THE ICDS EXPERIENCE

75
 Characteristics Dular Positive Deviance ASAT INHP TINP

76
3. Programme Management and Implementation

Community LRPs should be Opinion leaders are Gram Sampark Change agents None
involvement and residents of oriented on the Samooh (GSS) (CA) that focus on
mobilisation village, vocal, approach; per AWC 15–25 households Mother-linked Child
Community educated and Village health comprised of working with the Health Card
Monitoring tools active. committee is formed 18-25 members. support of AWW.
Collectively they from the local Each GSS They were
form a local residents of the member was selected by
resource group, village. responsible for community
LRGs which This committee 15-20 households members.Use
meets weekly assists the AWW at village level. of social map
with the AWW to and oversees the GSS coordinated to ensure
review progress entire programme. the activities, representation of
LRGs assist The committee including CA from all
AWW in helps to prepare registration of pockets of village.
distribution of village maps children and Efforts at
THR, indicating the houses pregnant women, involving
identification and of the positively mapping of the communities
enrolment of deviant and area/village to including change
beneficiaries and malnourished identify with agents / CBOs /
creating children in the malnourished/ PRIs in monitoring
awareness within village and tracking sick children, and supporting
the community of children for demonstrations behaviour change
POTENTIAL GOOD PRACTICES – THE ICDS EXPERIENCE

through immunisation, for preparing activities.

counselling and growth monitoring complementary Social Maps,
household visits. follow-up of food, preparation Wall Paintings,
 Characteristics Dular Positive Deviance ASAT INHP TINP

They are undernourished etc. of ORS, weighing Individual tracking

instrumental in Positive deviant children below 2 mechanisms
identifying mothers act as local years of age and
households with resource persons use of media/
pregnant and at the 12 day puppet shows to
lactating women. counselling session. impart IECD.
Dular Card, Community Competitions
adolescent Orientations are such as on
Cards held to create mehndi, acting
awareness on and poems were
under-nutrition. conducted to
Community growth stimulate cohort
Chart, Village maps, learning. Self-
PD Mascot, MCPC learning process
introduced at
meetings of
mahila mandals
and Kishori balika
mandals; Mamta
Card

Social cohesion Local Resource Village Health Gram Sampark Change Agents None
Groups Committee Samuh
POTENTIAL GOOD PRACTICES – THE ICDS EXPERIENCE

Collaboration with ICDS and Health ICDS, Health and ICDS and Health ICDS, Health and ICDS and State
other programme PRI Education PRIs Noon meal
Programme

77
 Characteristics Dular Positive Deviance ASAT INHP TINP

78
Staffing Block Utilised the ICDS Utilised the ICDS Support staff Additional Community
coordinators and health and health (technical and nutrition worker ateach
District support personnel at various personnel at programme) at centre, Community
team (DST) levels various levels. district state and nutrition supervisor for
Dular Cell at Block and District national levels 10 CHW and Block
state level coordinators in level community
some Districts. nutrition lady
instructors

Information sharing at District Dular Cell Block NCCS results None A brief set of indicators
all levels Monitoring Team level coordination displayed at each was reported monthly
monitors the committee shares AWC and shared from every
progress of the information in with community AWC.
centres using District level review MPR of NCCS Rapid assessments
MPR formats meeting. provided to conducted in select
and provides CDPOs and panel of districts.
guidance to DPOs HMIS collated at
village teams. Data analysed central level.
Block at District level Mother-linked Child
coordinator visit Health Card at Centre
centres and level
collects monthly Village MIS displayed
MIS and shares by CNW on CNC
it with District blackboard
POTENTIAL GOOD PRACTICES – THE ICDS EXPERIENCE

team. Community growth

chart displayed on
CNC wall
 Characteristics Dular Positive Deviance ASAT INHP TINP

Sustainability The approach is The approach tries Depends on As community The approach is
sustainable as to find solution from Convergence ownership was selective targeting with
capacity of within the mechanisms not sought within less emphasis on
local resource community hence between Health the programme community ownership.
persons are built it is practically Department, sustenance after
sustainable NGOs and ICDS. NGO withdrawal
The Gram led to collapse of
Sampark the mechanisms.
Samooh needs
to be organised
and consolidated
for effective
functioning.

Scale up Dular is a low Replication is Replication of Capacity building The approach was
cost replicable possible as recurring capacity building plans provide a gradually translated
strategy, which costs are low; Up inputs for the fairly robust into ICDS.
emphasises scaling can be done Gram Sampark mechanism of
systematic in short duration Samoohs, PRIs, scaling up.
involvement of SHGs and district In Demonstration
the family and and state level sites, the NGO
community and functionaries staff tended to
channelises their involves recurring marginalise the
effort and costs role of workers
POTENTIAL GOOD PRACTICES – THE ICDS EXPERIENCE

resources of ICDS and

towards proper RCH.

79
 Characteristics Dular Positive Deviance ASAT INHP TINP

80
development of The self-
the child monitoring tools
were scarcely
used as it was
process intensive.
Low scope of
mid-course
correction
changes
POTENTIAL GOOD PRACTICES – THE ICDS EXPERIENCE
 Annex B

Comparative Analysis of Impact on Malnutrition

Dular Positive Deviance ASAT INHP TINP

Malnutrition rates Overall prevalence of stunting Frequencies of WHO WHZ Child malnutrition did The mean weight of
(underweight) was significantly lower scores by district Z score not decrease 6 months old in 1990
reported between (p<0.01) in PD area (26.5%) WHZ>-0.99 35.6% ASAT are 360 g heavier
In AP, incidence of
the Dular and compared to control area and non-ASAT 38.5% -2.99 than in 1982 (6.5%
underweight increased
non-Dular villages (32%). <- WHZ<-2.00 ASAT 21% gain in weight).
from 25.7% to 29.2% in
as 55.5% and non-ASAT 20.2%
Prevalence of underweight the intervention area At 36 months age
vs. 65.4% WHZ<-3.00 ASAT 6.7% Non
(45.6%) and stunting and and from 28.5 to 30% the weight difference
ASAT 4.6% (p=0.314)
(25.2%) was significantly in control. from 1982 to 1990
lower (p<0.01) in the PD area Frequency of WHO HAZ was 650 g (6.2%
In UP, incidence of
compared to control area scores by district WHZ>- gain in weight).
underweight increased
(63.2% and 37.4% 0.99 ASAT 31.8% and non-
from 36% to 41% in the These differences
respectively) in children aged ASAT 26.1% and -2.99<-
intervention area and were statistically
12-17 months. WHZ<-2.00 ASAT 20% non-
from 36% to 38% in significant in all
ASAT 26.3% (p value 0.002
Weight for Age control monthly ages
level of significance)
between 6 and 36
In general, the proportion of However a pre-post
Frequencies of WHO WAZ months. Percentage
children with underweight evaluation across 8
score by district WHZ>-0.99 of children below -
(weight for age < Median- states saw an 8
ASAT 22.1% non-ASAT 2SD of NCHS
2SD) was about 43% in PD percentage point
19.7% -2.99<-WHZ<- ASAT decreased by 10.12
areas and 45% in control decrease in
26.% non-ASAT 28.1% (p percentage points
area, while that of severe underweight among
POTENTIAL GOOD PRACTICES – THE ICDS EXPERIENCE

value 0.636) between 1982 and

underweight (weight for age young children over 5
1990.
<Median –3SD) was about Frequencies of NCHS WHZ years. Decrease from

81
11% and 12% respectively. scores by district Z score
 Dular Positive Deviance ASAT INHP TINP

82
The prevalence of WHZ>-0.99 ASAT 31.9% 61% to 53% (> -2 Z Nutritional Status:
underweight in the age group and non-ASAT 36.0%, -2.99 scores) Severe Malnutrition -
of 12-17 months in PD area <- WHZ<-2.00 ASAT 21.3% declined by a third and
Mean weight for age Z
was significantly low and non-ASAT 20.1%, a half among children
score (WAZ) among
(p<0.01), compared to control WHZ<-3.00 ASAT 6.7% non- 6-24 months and by
children 12-17 months
areas ASAT 4.6% (p value 0.276) about half among 6-
(UP: baseline -2.00 and
60 months.
Height for Age Frequency of NCHS HAZ end line -2.20, AP:
scores by district WHZ>- baseline -1.66 and end Moderate malnutrition
The extent of overall stunting
0.99 ASAT 35.4% and non line -1.84) in decreased by 14% in
(Height for age<Median-2 SD)
ASAT 28.2% and -2.99<- intervention and in the 1st project area
children was significantly
WHZ<-2.00 ASAT19% non- control (UP: baseline and increased in the
lower (p<0.01) in PD area
ASAT 28.7% (p value of -2.09 and end line - area in 2nd and 3rd
(26.5%) as compared to
0.001 level of significance) 2.10, AP: baseline - phases.
control area (32%).
1.88 end line-1.88 and
Frequencies of NCHS WAZ Independent survey-
The prevalence of severe difference of -0.19 in
score by district WHZ>-0.99 severe malnutrition
stunting (height for age UP and - 0.18 in AP)
ASAT 20.5% non-ASAT 17% declined by 44% over
<median–3SD) was about
-2.99<-WHZ<- ASAT 30.8% 5-year period.
7% and 10% in PD and
non-ASAT 36% (p value
control areas respectively. Moderate malnutrition
0.124)
in new areas (where
Weight for Height
Weight for height Z score TINP1 was not being
About 14% of the children in means WHO WHZ ASAT - implemented) saw a
PD and 12% in control area 1.42 SE 0.039 non-ASAT - 23% reduction.
POTENTIAL GOOD PRACTICES – THE ICDS EXPERIENCE

were wasted (for height 1.31 SE 0.038 (p value

<Median-2SD). 0.044); NCHS WHZ ASAT -
1.37 SE 0.033 non-ASAT -
 Dular Positive Deviance ASAT INHP TINP

1.27 SE 0.032 (p value

0.036)

Height for age Z score

means WHO HAZ ASAT -
1.63 SE 0.071 non-ASAT
-1.92 SE 0.059 (p value
0.002); NCHS HAZ ASAT -
1.48 SE 0.063 non-ASAT -
1.73 SE 0.054 (p value
0.003)

Weight for age Z score

means WHO WAZ ASAT -
1.91 SE 0.049 non-ASAT -
2.02 SE 0.045 (p value
0.117); NCHS WAZ ASAT -
1.98 SE 0.046 non-ASAT -
2.08 SE 0.041 (p value
0.104)

Source: Evidence Review Growth Monitoring and Complementary Feeding July 2007
POTENTIAL GOOD PRACTICES – THE ICDS EXPERIENCE

83
 POTENTIAL GOOD PRACTICES – THE ICDS EXPERIENCE

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86
POTENTIAL GOOD PRACTICES – THE ICDS EXPERIENCE

NOTES

87
 POTENTIAL GOOD PRACTICES – THE ICDS EXPERIENCE

NOTES

88
 SERVICES OFFERED
HEALTH CHECK-UP

REFERRAL SERVICES IMMUNIZATION

SUPPLEMENTARY
NUTRITION

NON FORMAL PRE-SCHOOL NUTRITION AND HEALTH

EDUCATION EDUCATION