Integrated Child Development Services (ICDS) and Polio Eradication - Bihar

This PowerPoint presentation was part of a March 2007 United Nations Children's Fund (UNICEF)-hosted meeting dedicated to examining polio communication efforts, in the context of the final global push towards polio eradication. State-specific presentations for India's polio-endemic states (Uttar Pradesh and Bihar) were given by in-country communication and health practitioners. These were assessed by an external Technical Advisory Group (TAG) panel of experts who provided communication strategy recommendations based on evidence presented and data gathered on field-visits to endemic states. Communication strategies presented at this meeting were primarily focused on:

1. Analysing the results of programmes implemented to March 2007.
2. Detailing activities on national and sub-national levels, specific to social mobilisation, community engagement, underserved areas and media and political advocacy strategies.
3. Suggesting a planned communication programme for the next 6- to 12-month period, designed to support India's polio eradication efforts in the event of a resurgence of cases or population/programme fatigue.

This presentation gives an overview of the history and purpose of Integrated Child Development Services (ICDS); services offered through Anganwadi workers (AWWs); ICDS planned expansion process for 2007; strengths of AWWs in support of immunisation and community mobilisation; the contribution of ICDS in polio eradication; and areas for future improvements within the ICDS system.

ICDS was launched in 1975 to assure community services through a network of AWWs, village women working in their own communities. They provide support for a holistic programme for mothers and children in the following areas:

• Supplementary nutrition
• Pre-school education
• Immunisation
• Health check-up
• Referral services
• Health and nutrition education

ICDS has planned an expansion process in Bihar for 2007 that will increase the area coverage to 100%, in 532 identified child development blocks. This will involve the addition of 20,000 AWWs to bring the total in the state up to 80,000.

The network of AWWs brings the following strengths to support community mobilisation:

• They are all women from the same community or working areas, with one AWW for every 1,000 individuals.
• More than 80% of them are educated.
• They each have the support of an established Anganwadi Center.
• Each AWW has the assistance of an Anganwadi Helper.
• They conduct regular mother's meetings to address issues other than polio.
• They continually update surveys of pregnant women, newborns, 0-6 year olds and adolescents.
• Continual monthly or bi-monthly meetings facilitate training.

Anganwadi workers have played active roles in polio mobilisation activities, through newborn tracking, counselling of mothers between rounds, following up on X-marked houses, and dissemination of posters and other materials. Their contribution to polio programming in 2007 is evidenced by:

• >65% of teams including AWWs
• 45,372 AWWss involved as mobilisers in communities between rounds.
• 19,724 (43.4%) of AWWs engaged as vaccinators.

The following areas of the ICDS system are seen as opportunities for improvement:

1. Improved training materials for AWWs that are more practical for the field.
2. Incorporation of a polio module into regular job training and refresher courses.
3. Establishing a state ICDS monitoring system.
4. More rapid responses to issues through decentralised feedback.

In conclusion, the TAG panel was asked for strategic and technical support through the following two questions:

1. How to assure the best integration and expand the potential of both AWW and accredited social health activists (ASHAs)?
2. How to better measure newborn tracking success?

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