50 years of a nation-wide child development programme in India

Abstract

This article reviews the current status of the Integrated Child Development Services (ICDS) Scheme, India; the largest Early Childhood Care and Development (ECCD) programme in the world, at 50 years of its existence. While there has been substantial advance of this scheme in terms of coverage and quality, its thrust has remained on providing supplementary nutrition and much more needs to be done to achieve truly universal and comprehensive ECCD services. The major issues besetting favourable outcomes relate to inadequate investments resulting in poor infrastructure, inadequately remunerated and capacitated ICDS workers and an overcentralisation resulting in a critical lack of community engagement and contextual adaptation. Social legislation is likely to be required to promote the rights of very young children through the reinvigoration of this scheme.

Key Messages.

• The Integrated Child Development Services (ICDS) Scheme, run by the Government of India, is the largest Early Childhood Care and Development (ECCD) programme in the world and has achieved 50 years of existence.

• While intended as a comprehensive development programme, the major thrust of the scheme has been to address malnutrition.

• If the ICDS is to truly achieve its mandate of universal and comprehensive ECCD services, it requires a major revisioning and reinvestment.

• This would involve a proper institutionalisation of its structure to provide necessary infrastructure, recognition of the workers as skilled HR requiring adequate remuneration and support, as well as decentralised governance with community ownership.

• Social legislation is likely to be needed to provide impetus to these much-needed reforms.

Introduction

India is home to the largest child population in the world, with 164.5 million children under the age of 6 years counted at the last census in 2011. Early childhood is well recognised as a phase in the lifecycle that is critical to achieve full human potential in terms of physical, cognitive and social function as also reflected in the Social Development Goal 4, with Target V.4.1 aiming to ensure that all children have access to quality early childhood development, care and preprimary education by 2030.¹

However, much of the current gaps in achieving this target are housed in the regions of Asia, with India faring not as well as many of its neighbours. Considering that national data on child development is scarce for country comparisons, stunting is often taken as a good proxy indicator of child deprivation in multiple sectors. Table 1 gives a snapshot glimpse of the status of India alongside neighbouring countries.²

Table 1. Trends in stunting, select countries, select years.

Country	Survey years	Point estimate
Afghanistan	1997	53.2
	2022–2023	44.6
Bangladesh	1985–1986	70.9
	2022	23.6
Bhutan	1986–1988	60.9
	2023	17.9
China	1987	38.3
	2016–2017	4.8
India	1988–1990	62.7
	2019–2021	35.5
Pakistan	1985–1987	62.5
	2017–2018	37.6
Sri Lanka	1987	31.2
	2024	10.5
Thailand	1987	25.5
	2022	12.4

UNICEF/WHO/World Bank Group joint child malnutrition estimates 2025.

Where the status of early childhood education per se is concerned, not much national data are available. The National Education Policy (NEP),³ 2020, for instance, states only that ‘Presently, quality ECCE is not available to crores (10s of millions) of young children, particularly children from socioeconomically disadvantaged backgrounds’ (parenthesis added).⁴ However, an independent annual survey provides some information on children currently lacking any preschool education whatsoever as represented in table 2.⁵

Table 2. Percentage of children not enrolled in any kind of preschool or ECE centre (anganwadis, preprimary classes in government schools or private institutions).

Age (years)	Survey years	2024
3	2018 2024	28.8 20.7
4	2018 2024	15.6 11.4
5	2018 2024	8.1 6.2

Annual Status of Education Report (ASER) 2024.

Among other available indicators for the well-being of children in this age, India has made improvements on the immunisation front with the National Family Health Survey (NFHS) (2019–2021) reporting full immunisation coverage at 76.4%, up from 62% reported in NFHS-4 (2015–2016). However, 3.6% were completely unvaccinated (absolute zero dose) and 20.0% only partially vaccinated. Not having a vaccination card is noted as the category having the highest prevalence of zero dose children;⁶ a factor requiring correction at a systemic rather than behavioural level.

Given this context, it seems important to acknowledge and re-examine the Integrated Child Development Services (ICDS) Scheme; a central scheme run by the Ministry of Women and Child Development, that celebrates its mid-centenary birthday this year. Launched in 1975 and currently covering about 90 million children, 11 million pregnant and lactating women and 2 million adolescent girls in India,⁷ this is arguably the largest of such programmes across the world. This fact is noteworthy in itself, given that it is an entirely state-run programme in an era that discourages the welfare/social protection role of the state, but by no means its sole distinguishing quality. As the name suggests, and despite several iterations through the years and implementational challenges, it has been the retention of comprehensive intersectoral Early Childhood Care and Development (ECCD) services at community level that is its most valuable hallmark. This review restricts itself to the ECCD services intended for child beneficiaries from birth to 6 years of age.

History and progression

The theoretical understanding that underpins ECCD today, in terms of the unique significance of the early years for cognitive, nutritional, physical, social and emotional well-being is based on relatively new research. However, taking care of the very young has been an age-old challenge both at parental and societal level, as the well-known adage ‘it takes a village to raise a child’ acknowledges. Early work in this area was known in areas of India, with organisations such as the Guild of Service engaged in providing child welfare services from as early as 1924 in the south of the country. The Indian Council of Child Welfare, set up in 1958, too had been pitching for state-run child welfare services alongside some significant non-governmental organisations and individuals steadily advocating for the same. Finally, it was the Central Advisory Board of Education (CABE) that set up a ‘Committee on The Preschool Child’, chaired by Ms. Mina Swaminathan; an educationist, women’s rights activist and child rights activist, that developed a Report on the Preschool Child (1972) which led to the setting up of ICDS, the earliest state-run programme for ECCE/ECCD in India.⁸

Clearly, the origins of the ICDS were underpinned by concerns related to preschool education, with its inception through CABE and the acknowledgement of the ICDS as a key programme in the National Policy on Education (1986). However, given its integrated character, it was placed appropriately under the Ministry for Women and Child Development.

Coverage

Given that the ICDS is the only platform for the delivery of essential services for children up to 6 years of age at the community level, coverage is an important issue and determines access to basic child rights and services to a large extent. Initially, the scheme was limited to a very small number of ICDS centres (popularly known as ‘anganwadis’, or courtyard centres) covering only 33 (4 rural, 18 urban, 11 tribal) blocks (a geographical unit for community development covering approximately 25 000 to 100 000 population) of a total of 7256 blocks listed currently. This progressed to 3654 blocks in 1995⁹ and currently there is near ‘universal coverage’ through the existence of nearly 1.4 million Anganwadi Centres (AWCs) run by the Anganwadi Worker (AWW) and Anganwadi helper (AWH) as dictated by the NFSA (2013). However, coverage in terms of child population rather than geography remains short as detailed in the following sections.

Priority shifts

Over the years, it is interesting how different issues have come to dominate in various phases of these schemes, in reflection of global and national priorities. India has the dubious distinction of housing the greatest number of malnourished children in the world and the nutrition of Indian children has come to take centre stage even within global fora concerned with the well-being of children. Though the ICDS came about by dint of a focus on preschool as mentioned above, subsequent policy and programme shifts have undoubtedly created a higher focus on nutrition within the various elements of ECCD. As early as 1998, the state of Tamil Nadu, often considered a pioneer in support to nutrition, created the Tamil Nadu Integrated Nutrition Project 1989 which included the ICDS alongside the schemes for Mid-Day Meals in schools. The state received World Bank (WB) funding from 1998 onwards for the purpose of eradicating child malnutrition from the entire state with a focus on ICDS nutritional services.¹⁰ This was scaled up with WB providing additional funds to National Nutrition Mission from 2018 to 2022 and ICDS Systems Strengthening and Nutrition Improvement Project (ISSNIP) from 2012 to 2022, to improve the coverage and quality of ICDS nutrition services to pregnant and lactating women and children under 3 years of age across all states of India.

The ICDS in Law and Policy; 2000-onwards

Meanwhile, very significantly, the scheme of ICDS achieved a legal scaffolding under the National Food Security Act (NFSA), 2013, that declared the provision of nutritious meals through the ICDS a universal entitlement for all children, thus necessitating the scale-up of the ICDS to 1.4 million centres. It also laid out norms for additional provisions for malnourished children.

Various processes have occurred to strengthen and restructure the ICDS over the years that have largely focused on improving programme management rather than changing the character of the scheme substantively. The ICDS ‘Mission Mode’ was declared in 2012 with the laudable objective of making the anganwadi a ‘vibrant ECD centre’ at village level. The mission document¹¹ acknowledged the need to take the anganwadi beyond the image of being a ‘feeding centre’, and adopted a comprehensive approach to all the elements of child development. However, much of the focus remained on nutrition in terms of its implementation with four of five indicators of achievement being related to nutritional outcomes. It also declared that 5% of AWCs would be converted to AWC-cum-Creches (AWCCs) considering that there had been a poorer focus on children under the critical age of 3 years within the anganwadi system; a promise that has not made good until.

Subsequently, the ICDS has undergone changes in nomenclature through combination or integration with other nutritional programmes in varying permutations and combinations such as its integration into the National Nutrition Mission (Poshan Abhiyan) in 2017 and Saksham Anganwadi and Poshan V.2.0 in 2022. It is to be noted, however, that the overall thrust has remained nutrition, though parallel and less visible processes have been ongoing to promote early education, with the inclusion of ECCE within the NEP 2020³ that identifies standalone anganwadis as a site for ECCE activities. Where child protection is concerned, a formal integration has barely been attempted with the bulk of services within the Integrated Child Protection Scheme¹² being largely left to civil society groups. A very recent protocol has been brought out by the Ministry of Women and Child Development to facilitate early diagnosis, referral and integration of children with disability through the ICDS in recognition of the fact that the anganwadi is intended for all children.¹³

However, it does not mention any special materials for the children or support to the AWWs for this purpose at the facility itself.

In recent times, the policy move to digitalise this system and verify beneficiaries through mandating identity documents and facial recognition has been found to be a challenge for communities that are already geographically and socially marginalised and are not able to ensure compliance.^{14 15}

Basic structure and services

Population norms

The ICDS is a central scheme with norms that are largely fixed and uniform across the country. However, flexibilities have been created to some extent, to suit different contexts. Thus, population norms have been created that allow for 1 AWC for a population of 400–800 and reduced to 1 AWC per 300–800 for Tribal/Riverine/Desert, Hilly and other difficult areas. Additionally, there is a provision of a Mini AWC offering only partial services; mostly supplementary nutrition, for populations of 150–400 that may have insufficient numbers of children to justify a full-fledged anganwadi. Interestingly, the rules allow for an Anganwadi on demand where a settlement has at least 40 children under 6 years of age but no AWC; however, this hardly translates in practice, remaining one of the causes of the coverage hovering around 50%–60% even according to outdated census figures of 2011.

The services

The six basic services comprise supplementary nutrition, preschool non-formal education, nutrition and health education, immunisation, health check-up and referral services. The nutrition services further expand into critical activities of growth monitoring and anthropometry, the provision of take-home rations for children under the age of three and pregnant and lactating women, the provision of hot cooked meals for children from ages 3 to 6 years who attend the centre for ECCE activities and special rations for children in severely malnourished categories. All six services are to be delivered by one AWW and one AWH per AWC. The AWWs further are expected to carry out home visits as well as facilitate the Village Health, Sanitation and Nutrition Day (VHSND) where there is convergence with health activities such as immunisation, antenatal check-ups and attending to mild illnesses. Though the AWC is expected to run for a few hours a day, practically speaking, it is more or less full-time for the AWW and helpers with 21 core responsibilities and 11 registers to fill with the addition of the online Poshan Tracker (PT).

The Anganwadi Workers (AWWs)

Despite their onerous duties, AWWs and AWHs are considered ‘honorary’ workers and do not receive the status, remuneration and benefits of being full-fledged employees. A time-use study confirmed that AWWs work about 6 hours a day, with 52% of their daily time directly serving children (26% on preschool work, 15% on feeding and 11% on childcare) and paper register work taking up 14% of daily work time.¹⁶ Other studies too find that AWWs work 6–9 hours a day with about 50% of their time being spent on ECCE activities.¹⁷ Nonetheless, AWWs are considered honorary workers and paid a monthly honourarium that is currently fixed at 4500 INR/- (about US$52) which is less than the minimum prescribed wage of even an unskilled worker, though some individual states have enhanced their share for somewhat better wages with the rare case of Tamil Nadu providing up to 19 700 INR extra for those with the highest experience and qualifications.¹⁸ They receive some social security in the form of maternity entitlements of 180 days and some insurance coverage, but no pensions. Expectedly, there has been a long-standing demand by the workers of this very critical 50 year-old scheme to be regularised and be treated as full-time regular workers rather than honorary workers.

Current status

While the scheme is considered well conceived and a matter of national pride, there do remain many challenges and gaps with respect to the quality of services and its outcomes with respect to comprehensive child development. Evaluations of this giant scheme have been few and far between, though several civil society organisations and movements, such as the Right to Food Campaign,¹⁹ have steadily advocated and mobilised on the ground to improve anganwadi services.

General functioning

A relatively recent evaluation by the NITI Ayog²⁰ (erstwhile Planning Commission) of the Government of India highlights some less discussed issues while it reinforces the general impression that uptake is highest for supplementary nutrition, lower for ECE and lowest for health and nutrition education. It notes that there is a significant gap in utilisation between urban and rural areas, with 59.6% of children from rural areas and only 40.2% of children from urban areas receiving at least one of the ICDS services. From the point of equity, it notes that utilisation is higher among mothers from middle income groups in rural areas, but this trend is reversed in urban areas with anganwadis serving lower income groups more. While there is a high demand for SN, it notes that diversity and quality leave much to be desired with inadequate budgetary allocations to better these. Where ECCE is concerned, it points to several challenges related to inadequate space, materials and play areas, but also that the community perception of the AWC as a site for ECCE is very low. It makes the important point that there is no modification of materials to suit children with special needs. Nonetheless, perhaps the only existing national study that provides evidence of the positive impact of the AWC on ECE/ECCE²¹ suggests that the ICDS has a positive impact on cognitive achievement, primarily for girls and children in low-income families, especially for reading and arithmetic.

For all these findings and several others related to infrastructure and human resources, state-specific variations were found to be very high, indicating a large range of functionality. However, the lack of toilets was uniformly high across all states and union territories.

As per the PT, the only national Management Information System (MIS) that currently pertains to the ICDS, although with reference only to nutrition, about 8% AWCs remained open for less than 15 days a month as on 31.5.25, with 78% remaining open for at least 25 days, though field realities might be different. Of the eligible beneficiaries, only 56% received supplementary nutrition for at least 15 days.

Similarly, the Demand for Grants, 2024–2025, of the Government of India²² noted that only about half of the total AWCs were operating out of their own government buildings and this figure remains at 49% even on 31 May 2025 with no improvement as per the PT dashboard. Additionally, 35% did not have functional toilets and 36% did not have drinking water facilities. It also noted that the Ministry of Women and Child Development had set a target of setting up 17 000 AWCCs by 2026 but as on December 2023, only 5222 AWCCs had been approved with a measly 2688 creches operational by May 2023. It further observed that there was an overall underutilisation of budgets for AWCCs by about 85% in 2021. The National Creche Scheme dashboard of the Ministry, however, reported an even lower number (1918) of AWCCs as on March 2024.

Of the ‘two honorary’ workers, the AWW and AWH, there is a shortfall of about 5% AWWs as per the PT, which does not track helpers in real time though they actually perform much of the work often in the absence of non-local AWWs commuting for variable days in a week from home. However, as per a Government PIB in 2024, there was a shortfall of about 27% AWHs which implies that 27% AWCs would have either no or one worker to perform all its functions. Even more critical is the fact that as in 2018–2019, 30.1% of sanctioned positions for Child Development Project Officers (senior supervisors; CDPOs) and 27.7% of sanctioned positions for supervisors were vacant across the country with some states showing up to 40% vacancies among CDPOs,²⁰ pointing to a highly fragile environment for supportive supervision.

The ICDS and nutrition

Given that the main thrust of the ICDS has remained supplementary nutrition, and that we are grappling with a fairly chronic high prevalence of malnutrition combined with a very low quality of dietary diversity and quality, the SNP does come under a fair bit of scrutiny. However, it is important to note that the secular improvements in malnutrition cannot be solely attributed to the ICDS, considering the multifactorial nature of malnutrition; nor can the lack of acceleration on nutritional outcomes be placed solely at its door. Little data, in fact, exist to showcase a direct impact while the scheme is undoubtedly considered a source of food security for children.

To detail this for context, the most recent nationwide survey on household characteristics; the National Family Health Survey 5 (2019–2021) places stunting at 35.5%, wasting at 19.3% and underweight at 32.1%.²³ The PT, in juxtaposition (though the data sets are not directly comparable), puts these figures at 37% for stunting, 5% for wasting, 16% for underweight and 6% for overweight as on 31.5.25 from ICDS records. Shockingly, according to NFHS 5, only 11% of all children aged 6–23 months are fed a minimum acceptable diet and studies²⁴ suggest that the dietary diversity failures further correlate positively with anaemic children comprising 67% of children under 6 years. Several pathways have been identified for failures of Infant and Young Child Feeding (IYCF) and it is notable that exclusive breastfeeding remains at 64% and timely complementary feeding at 46% as per NFHS 5. While IYCF is constrained by several structural and systemic factors including the lack of maternity entitlements for women in the informal sector, the ICDS has a facilitatory role for most of these factors and a direct role in providing supplementary nutrition.

Issues related to the supplementary nutrition programme (SNP)

Several factors hinder the implementation of the SNP as an intervention in tackling the issues described above, especially those related to the lack of dietary quality and diversity. The budgets for SNP have been enhanced from time to time and currently lie at Rs 8 (US$0.1) per day for children and Rs 9.50 (per day for pregnant and lactating mothers and adolescent girls (14–18 years) (wherever applicable) for 300 days a year. Severely malnourished children are allocated Rs 12 per day. These have been deemed inadequate²⁵ to provide a nutritious meal or meet the demand for eggs, milk and fruits and vegetables that have been longstanding. There is also no attempt to connect to the village community in rural areas for the utilisation of culturally acceptable local produce and the use of community-approved menus. Decisions on food and feeding remain highly centralised and top-down, also causing several logistical issues such as delayed procurement and payments leading to delays in distribution. Since younger children are provided with take home rations (THR), sometimes of unacceptable quality or kind,^{26 27} the THR often does not ultimately find its way to the intended ‘beneficiary’. Compounded with this is the fact that the government has chosen to invest in mandatory rice fortification for the containment of anaemia rather than in enhancing dietary diversity of the meals being provided for a population that is already partaking primarily of cereals and carbohydrates,²⁸ once again without any consultation with affected communities. These factors contribute to relatively slower gains in nutrition, considering the investments by the government over so many decades.

In terms of measuring outcomes, several problems beset the use of data, especially through the PT to identify, manage and track children with malnutrition, as well as take stock of trends at local levels.²⁹ Consolidated dashboard data are not available at centre level for the AWW to routinely monitor the status of the child-community at her centre, though she does have information on individual children. There has been much written up about the several challenges of doing anthropometry, filling in data and analysing the data, relating to poor capacities for height measurements in particular, lack of functional instruments, poor internet connectivity and lack of time. There are also reports of an environment that encourages under-reporting of severe malnutrition within the ICDS.³⁰

Convergence with the health sector

The health sector comes into play with the ICDS in several ways, though it is governed by a separate ministry causing challenges in achieving convergence.³¹ All children enrolled in the AWC are expected to be screened through the ambitious Rashtriya Bal Swasthya Yojana (RBSY) for ‘Defects, Diseases, Deficiency and Developmental Delays including disabilities’ once every 6 months and be provided free seamless continuity across various levels of medical care if required. The AWW is expected to identify common childhood illnesses and liaise with the frontline workers of the health sector: the Accredited Social and Health Activist (ASHA) and the Auxiliary Nurse Midwife (ANM). There is a process of referral for children with Severe Acute Malnutrition (SAM) to be admitted to Nutritional Rehabilitation Centres (NRCs) for immediate treatment and establishment of weight gain through intense nutritional inputs. At the village level, the frontline workers of these programmes engage during Village Health and Nutrition Days where the AWW is charged with ensuring attendance, distribution of supplementary nutrition, growth monitoring and referral. In turn, the ASHA and ANM take charge of immunisation, antenatal care, postnatal care and treatment of minor illnesses. Several gaps still remain in the implementation of these important programmes. While the RBSY has not been evaluated nationally, a few small state-level studies exist that point to staffing gaps, low capacities and patchy infrastructure affecting the implementation of this programme.^{32 33} However, the most critical issue remains the dearth of upstream health sector action for children suffering from severe health and developmental problems requiring secondary, tertiary or multidisciplinary care; and this is reinforced by our own field experience for over three decades. The NRCs function relatively well where present, but families of children with SAM resist admissions for the prescribed 2 weeks since they are usually at a distance, and the disruption of wages and agricultural and household duties is an opportunity cost not affordable for them. The trends in immunisation have been largely positive with full vaccination coverage at 76% as per the NFHS 5. However, there are large state-level disparities within this as well, with the gap being maximal in tribal and hilly areas.³⁴ All these factors contribute to challenges for ECCD for which the ICDS is primarily responsible, since the governance of both sectors lies in separate ministries and departments.

Conclusions

To conclude, India should be justifiably proud of running and sustaining a nation-wide universalised state-run ECCD programme for children under 6, as well as women in the context of pregnancy and lactation. However, at the respectable age of 50, if this programme is to truly succeed in delivering equitable and accelerated outcomes for all children, it requires a massive reinvestment and revisioning. The main structural and systemic issues remain its highly centralised top-down character, which fails to allow community participation and ownership, and the failure to institutionalise it as a system as stable as schools and healthcare services; requiring regular HR and decent infrastructure. The comprehensiveness and indivisibility of services related to early stimulation, nutrition, health and care needs to be re-established beyond the current focus on nutrition, which nonetheless needs to be maintained. Perhaps these deep changes can only become possible if the entire scheme is elevated through a law that upholds ECCD services as a universal right; much in the same way that the NFSA was able to do for its nutrition component; but with greater attention to decentralised, contextually appropriate governance alongside adequate tax-based funding.