Convergence of services between NRHM and ICDS
Convergence of services
Nutrition
NACP
NVBDCP
NCCP
PEOPLE
SHP
IDD
NBCP
PFA&
D
Education
IDSP
RNTCP
CURRENT FUNCTIONING OF ANGANWADIS
Figur e 9.6: P er cent age of childr en age 0- 71 mont hs r ecieving ser vices f r om an AWC
100
Not receiving supplementary food
Any services
Almost daily receving supplementary food
80
60
40
20
0
<12
12-23
24-35
36-47
48-59
60-71
Source Reference 9.8
During the first 2 years, less that a third of the
children received any services and the proportion
receiving food supplements were negligible. In the
other age groups only one-fifth had received
supplementary food.
120
100
Figure 9.7: Percentage of children 0-59 months in areas covered by AWC by frequency
of weighing
%
80
60
40
20
0
<12
Source Reference 9.8
12-23
24-35
Not at all
36-47
Atleast once a month
48-59
Atleast once in three months
Inspite of guidelines specifying that monthly
weighing of children should be done in the crucial 024 months age group, the percentage of 0-12 and 1223 months old children who were weighed every
month was negligible. Among the 2-6 years old
children, less than 10% have been weighed once in
three months
Figure 9.9: Interstate differences in services received during pregnancy
Mizoram
Goa
Meghalya
Himachal Pr.
Karnataka
Sikkim
Andhra Pr.
Gujarat
Rajasthan
Assam
Uttar Pr.
Punjab
J&K
Delhi
Bihar
0
10
20
Supplementary food
NFHS -3
Source: Reference 9.8
30
Health check-ups
40
50
NHE
60
70
There are huge
interstate
differences
in
pregnant women
accessing
AW
based
services
Compared
to
other states Delhi
performs
poorly
in ICDS based AN
services.
This
might be partly
attributable
to
ready access to
ANC in hospitals
and relatively low
poverty ratio in
Delhi
Figure 9.10: Percentage of children 0-71 months receiving any services from an AWC
Chhatisgarh
Madhya Pr.
Meghalya
TamilNadu
Jharkhand
Nagaland
Karnataka
India
Kerala
Manipur
Haryana
Uttar Pr.
J&K
Punjab
Bihar
0
Source: Reference 9.8
NFHS 3
10
20
30
40
Percentage
50
60
70
There
are
large
interstate differences
inchildren accessing
anganwadi services .
In Delhi proportion
ofchildren accessing
anganwadi is low .
This might be due to
low poverty ratio,
ready access
to
hospitals providing
child care and lack
of
space
in
anganwadi
where
children could sit
and participate in
activities .
Coverage under health mission
PRIMARY HEALTH CARE & NUTRITION PRIORITIES
Detection and correction of undernutrition and anaemia
in pregnancy
Coping with low birth weight neonate
Reduction of IMR, high morbidity and undernutrition
during infancy
Reduction of under five mortality rates& high
undernutrition rates in preschool children
Reduction in anaemia in Indians
Ensuring universal access to iodised salt by 2010
Ante natal/intrapartum care
Current status
ANC coverage is low; content is suboptimal.
Majority do not get weighed; detection of undernourished pregnant women and
targeted food
supplementation and health care for those with undernutrition not operationalised
Very few get Hb estimation done; appropriate management
of anaemia is non existent; consumption fo IFA tablets low
Majority go to hospital for delivery but care in home
deliveries is poor
What can convergence between ICDS and Health
Mission can achieve ?
Essential antenatal care for all pregnant women can be provided
during the village health and nutrition days
AWW, AW helper and ASHA can inform women so that they
reach a common place where ANMs can examine them and give
appropriate advice, IFA tablets , TT injections and also refer
those with problems.
Most of Delhi anganwadi’s do not have enough space where
pregnant women can be brought together for examination and
advice However near most anganwadis there are community
halls, dharmshalas.By approaching appropriate authorities, it
might be possible to get the health and nutrition day as well as
immunisation day organised in these buildings.
As all pregnant women are collected in one place,group
counseling will be possible.
ANM can examine all women and get the forms completed with
the help of the AWW, give TT injections and IFA tablets.
Under weight women can be identified and AWW worker can try
to provide food supplements on priority to them.
Women requiring referral can be identified and ASHA can help
them in reaching hospitals for care.
Synergy in delivery care
Decision regarding place of delivery (domiciliary & health
facilities). ANM will identify low risk women who can deliver
at home;
AWW and ASHA can monitor for clean delivery ;if there are
complications during delivery ASHA can help the woman to
access emergency care at the right place. All Anganwadis
should have information on nearest hospital where
pregnant women could be referred
In home deliveries AWW can weigh all neonates ( in Delhi
perhaps 5 / year in an anganwadi) , identify those weighing
less than 2 kg and refer them to nearest hospital for care;
AWW should have the nearest hospital where neontes can
be referred; ASHA may facilitate referral
This will help in reducing the neonatal mortality in home
deliveries
What can an AWW do to reduce IMR
Weigh home born babies soon after birth; refer those who
weigh less than 2.2 kg
Ensure early initiation of breast feeding
Ensure exclusive breast feeding for first six months
Collect infants in AWC on immunisation days so that infants
get immunised on schedule by the ANM
Provide nutrition education and enable the mother to give
adequate quantities of appropriate complementary feeds
from home food
Advise regarding feeding during illness and convalescence
Act as depot holder for ORT,
Immunisation days can be utilised for providing
immunisation and for advice regarding infant feeding
and caring practices and contraceptive care
Immunisation rates can go up rapidly if there is good
coordination between the AWW and the ANM
During immunisation days the AWW and ASHA can
collect the children and pregnant women
ANM can immunise them in the anganwadi, advice
mothers regarding appropriate infant feeding and
caring practices and provide contraception related
counseling
Convergence of services
AWW can
weigh neonates in home deliveries and refer
those requiring care
advise regarding exclusive breast feeding and
complementary feeding
identify undernourished pre-school children
by weighing them at least once every three
months and give food on priority to them;
act as depot holder for ORS.
assist in emergency referral
Convergence of services
ANM will
 Immunize all infants, pregnant women and
children as per schedule.
 Screen children – especially the under nourished
ones for health problems and manage/ refer
those with problems.
AWW will
 Assist ANM in organizing immunization health
check ups in anganwadi;
 Assist ANM in administering massive dose
Vitamin A