The government of India started the ICDS program in 1975, with support from UNICEF. The government perceives child development to be hindered by “poverty, poor environmental sanitation, disease, infection, inadequate access to primary health care, and inappropriate child care and feeding practices” (Government of India, 2000). The ICDS programs aims to alleviate some of these problems by providing a holistic package of services, including:

- Supplementary nutrition and some basic health services for children aged below 6

- years, and pregnant and lactating mothers

- Nutrition and health education for mothers, and

- Growth monitoring, de-worming, and pre-school education for children.

To do this, ICDS ( _Anganwadi)_ centers are established in villages in selected administrative blocks. Most of these are in rural and tribal areas: only 6 percent of the sanctioned ICDS blocks in 2003 were in urban slums (Parliament of India 2003). The center is staffed by an _anganwadi_ worker (AWW) whose task is to provide some services directly to a rotating roster of children and pregnant women. Health and nutrition education is given by visiting homes of women who are pregnant or have infant children. The worker is also expected to liaise with other frontline workers, in particular from the health department, to assure that children and pregnant women receive key frontline MCH services, including immunization, health check-ups, and referral services. They are responsible also for ensuring ancillary health services, such as distributing folic acid to pregnant women, and de-worming children.

A large number of monitoring studies<sup>11</sup> indicate that the ICDS program has many problems with implementation, as well as program design. One major implementation problem is that AWWs are inadequately trained, supervised and supported, while their duties require considerable understanding of nutrition, pre-school education, and maternal and child health issues. A second problem is erratic provision of supplies<sup>12</sup> , and leakage in food procurement. Thirdly, the food supplementation is poorly targeted: it is not confined to malnourished children, and reaches mostly children aged 4-6 years old, who are past the optimal window for influencing growth.<sup>13</sup> Problems of program design include a lack of community participation (Greiner and Pyle 2000). The program is run in a very top-down fashion, with all the logistical and implementational inefficiencies and rigidities that such an approach entails, and workers are not accountable to the communities they serve. Also, the heavy focus of the ICDS on nutritional supplementation leads to the relative neglect of other more cost-effective approaches to improving nutrition outcomes. This would include efforts to improve

> 11 See, for example, NIPCCD 1992, NCAER 2001, Allen and Gillespie 2001, Greiner and Pyle 2000, and Bredenkamp 2004.

> 12 A national evaluation (NIPCCD 1992) in 1992 found that the average AWC was without food for 20 percent of the time, and for more than a quarter of the AWCs this was for over 30 percent of the time.

> 13 Allen and Gillespie 2001:36.  Many of these problems were addressed in Tamil Nadu’s modification of the ICDS program (TINP), which halved the prevalence of severe malnutrition in the villages in which it was implemented by targeting the food to the needy and requiring them to eat it on the premises instead of taking it home to share with others (Heaver 1989, Greiner and Pyle 2000).

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