Assessment of Integrated Child Development Services (ICDS) at Grass Root Level in an Urban Area, Raigad District, Maharashtra

Background: ICDS is an integrated program intended for Maternal and Child Care which adopts a holistic, lifecycle approach. Its main focus is on health, nutrition and education. Urban ICDS caters to the vulnerable urban slum population. Despite the program running for four decades its impact on its beneficiaries is still slow. The Anganwadi worker and helper are the grass-root functionaries running this program through Anganwadi centre. Hence this study was conducted to assess the functioning of the Anganwadi centre. Methodology: A Descriptive Cross-sectional study was conducted at all 15 urban-ICDS Anganwadi Centres of Khopoli during September-November 2019. The Anganwadi workers and helpers were interviewed regarding their sociodemographic details, knowledge and challenges perceived to run the centre. Observational Checklist designed based on guidelines and standard proforma for monitoring of the ICDS projects was used to assess infrastructure, equipment and registers. Results: Out of 14, 11(78.57%) Anganwadi workers had more than a decade experience. Indoor space of 600 sq.ft was available in 7(46.67%) centres. Toilets with running water were available in 9(60%) Anganwadi Centres and 6(40%) were linked to the school. Functional Salter’s weighing scale was available in 11(73.33%) Anganwadi centres. All 12 registers were available in 9(60%) Anganwadi centres. The utilization of services by pregnant women was the highest. Partially immunized children were present in 2(13.33%) Anganwadi centres. The service gap was highest (100%) with health check-up. Conclusions: There is a gap in the availability of infrastructure and utilization of some services. Key-words: urban ICDS, Maharashtra, Service gap INTRODUCTION Integrated Child Development Services (ICDS) was launched with a vision to provide a holistic package using a lifecycle approach under one roof. The main thrust is on the villages and slums which comprise 75% of the population. The impact of this scheme has made a difference in the health and development of the vulnerable groups in India. But even after four decades since the launch of this programme, NFHS4 data states that 32.4% pregnant women received full antenatal care, 36 % children were malnourished and 56.2% children fully immunized in Maharashtra. [1] The Anganwadi worker and Anganwadi helper through the Anganwadi Centre are responsible for bridging the service utilization gaps between the vulnerable groups and the healthcare system. Many studies over past years have brought to light that most of the problems revolve around the Anganwadi worker and the Anganwadi Centre itself. [2-4] Poor and inadequate infrastructure can create hazards and health problems for the children attending the Anganwadi and can cause loss Priyanka Mary Wilson et.al. Assessment of integrated child development services (ICDS) at grass root level in an Urban Area, Raigad District, Maharashtra. International Journal of Research and Review (ijrrjournal.com) 338 Vol.8; Issue: 5; May 2021 of beneficiaries. Lack of manpower and poor remuneration are additional factors that can affect the delivery of Anganwadi services. Development and formation of the metropolitan regions have led to an increase in social and economic disparities within the urban communities which shelter one-fourth of its population in the slums. The health status of these people living in urban areas is no better than the rural areas. [5] So, this study was conducted to assess the infrastructure, manpower and utilization of services provided by the urban-Anganwadi Centres. METHODS A Cross-sectional study was conducted in the urban-ICDS of Khopoli, Raigad district, Maharashtra which is the field practice area of Urban Health Training Centre under the Department of Community Medicine, MGM Medical College, Navi Mumbai. All the 15 Anganwadi Centres were selected for the study. The study was conducted during September-November 2019 (3 months) after obtaining the approval from the office of Child Development Project Officer, Raigad district and the Institutional Ethics Committee. A pre-tested semi-structured questionnaire was used to collect the data through personal interview from the Anganwadi workers and the Anganwadi helpers regarding their socio-demographic profile, knowledge and perceived challenges regarding the services provided at the Anganwadi Centre after taking an informed written consent. The data to assess the infrastructural facilities, services provided and recordkeeping was collected using a pre-tested observational checklist prepared based on the guidelines and standard proforma for monitoring of the ICDS projects specific to Anganwadi workers set by the National Institute of Public and Child Co-operation Development (NIPCCD) and CBMP Maharashtra tool. [6-7] The data obtained was analysed on MS Excel 2019 and expressed in proportions and percentages. RESULTS Among the total 15 Anganwadi Centres, 2 were in tribal areas and the rest 13 were in urban slums. They catered to a population ranging from 850-1300 with a mean of 1099. There were 14 Anganwadi workers and 13 Anganwadi helpers. The sociodemographic profile of the Anganwadi workers and Anganwadi helpers are depicted in Table 1. Table 1: Sociodemographic profile of the Anganwadi worker (n=14) and Anganwadi helper (n=12)