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Strategy for child survival

Jul 07, 2009

Vikas Samvaad’s publication Moribund ICDS: A study on the ICDS and Child Survival Issues in Madhya Pradesh throws light on the dismal scenario of early childhood care and development in western India. The report suggests comprehensive measures to improve the health of children under six.

Moribund ICDS: A study on the ICDS and Child Survival Issues in Madhya Pradesh

Publishers: Sanket - Centre for Budget Studies, Vikas Samvad and the Right to Food Campaign Madhya Pradesh Support Group, 2009

This study is a timely report on malnutrition and food insecurity on children in Madhya Pradesh and the functioning of the Integrated Child Development Scheme (ICDS).

On one hand when the economy of the state is glimmering with rising GDP on the other hand one out of every two children in the Madhya Pradesh succumbs to malnutrition.

It is not just a coincidence that the state scores the top position for highest Infant Mortality Rate (IMR), lowest life expectancy of 57.7 years in comparison to Indian average of 63.2 years and also staying top in list of Indian states with more than 60% malnutrition among children under the age of five years.

Alarmingly, the situation is critical among the tribal children where 140 out of every thousand live births die before celebrating their fifth birthday.

The Lancet, world’s renowned medical research journal, establishes that the death chances due to diseases like diarrhea, measles and malaria for a malnourished child increases 9 to 18 folds as compared to a normal child.

WHO and UNICEF also unanimously agree that malnutrition is the major killer of children less than five years.

Nearly 12 million (16%) of the population in Madhya Pradesh is below six years age, needs health, nutrition and development care. However, budgetary allocation for this section is just Rs 156 crore in the health and Rs 325 crore in ICDS which comes out to Rs 400 per child per year only.

The past 35 years of experiences of ICDS are indicating many shortfalls on the account of convergence and coordination among implementing government departments.

Also, one cannot ignore the truth that 6.6 million households in the state are surviving below poverty line. These households are unable to live their life without the state support.

Moreover still more than half the districts of Madhya Pradesh are lacking the basic health services and infrastructure facilities.

In fact, ground reality of ICDS implementation is too dismal. Considering the severity of the problem of persisting malnutrition in the state, it is lacking more than 40,000 anganwadi centres at present. Many of the centers lack regular supply of supplementary nutrition food, growth registers, weighing machines, playing kits, medicine kits, and drinking water facility. Besides, anganwadi workers are not getting their remuneration timely but showing the long time lag from 7 to 14 months.

Any policy on Early Childhood Care and Development should focus on providing holistic and comprehensive care for children under six, and contain the following essential components:

  • A system of food entitlements, ensuring that every child receives adequate food, not only in terms of quantity but also in terms of quality, diversity and acceptability. The food should be locally procured and produced by village communities, womens SHGs, mahila mandals or the most appropriate decentralised village forum.
  • A system of childcare that supplements care by the family and empowers women. Such care needs to also address their learning needs and must be provided by informed, interested adults, with appropriate infrastructure.
  • A system of health care that provides prompt locally available care for common but life threatening illnesses. Such a system needs to address both prevention and management of malnutrition and disease.

Based on this framework, the following are the ten essential interventions required to be put in place:

  1. Universalised maternity entitlements
  2. Exclusive breastfeeding for children up to six months
  3. Skilled counselling and nutritional support for children under three
  4. Pre-school and hot, cooked meals for all children in the age group of 3-6 years
  5. Day Care Centres or Crèches
  6. Second Anganwadi Worker for ICDS Centres
  7. Convergence between Health and WCD Department at all levels including provisioning of basic Health Care Services including Nutritional Rehabilitation Centres for highly malnourished children
  8. Investing in the ICDS workforce through training and capacity building
  9. Building a comprehensive monitoring and evaluation system
  10. Improving governance and involving communities


For more details on the report, please contact Sachin from Vikas Samvad, sachinwrites@gmail.com , Tel: 9977704847

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