Table 1 Background on Village level health and nutrition programmes

The Integrated Child Development Scheme (ICDS)

Launched in 1965, ICDS is designed to provide integrated health, nutrition and education services for children from 0 to 6 years of age and for pregnant and lactating mothers. The scheme is overseen nationally by the Ministry for Women and Child Development (WCD). Services are provided through Anganwadi Centres (AWCs), served by honorary but compensated staff members, the Anganwadi worker (AWW) and Anganwadi helper (AWH). Each AWC caters to a population of approximately 1000, with the roles of AWWs and AWHs usually assumed by women appointed within the community.

To date, the ICDS structure has concentrated on delivering a package of interventions focused on the following six areas:

• Supplementary nutrition;

• Growth monitoring;

• Maternal and female health counselling;

• Immunisation;

• Wider health and referral services; and

• Pre-school education.

The National Health Mission

Delivery of a wider set of “nutrition-specific” interventions proven to have an impact on maternal and child undernutrition (Bhutta et al. 2013) is dependent on a number of wider health services provided to the community (Avula et al. 2015). This includes services funded and delivered by the Ministry of Health and Family Welfare through the National Health Mission (NHM, formerly National Rural Health Mission), an umbrella scheme launched by the Central Government in 2005 with the objective of reducing the maternal mortality, infant mortality and total fertility rates. The NHM provides for a number of service guarantees free of cost to individuals living below the poverty line (BPL) (NRHM Service Guarantees, GoI). These include services such as:

• Antenatal care (ANC) check-ups;

• Cash benefits encouraging institutional delivery;

• Postpartum visits and IYCF counselling service;

• Supplementation of Iron and Folic Acid (IFA) from twelve weeks of pregnancy; and

• Prevention and control of childhood diseases like malnutrition.

Importantly, the scheme introduced the role of ‘Accredited Social Health Activists’ (ASHAs)^a to serve at community-level as the main link between health supply and demand. Similar to AWWs, ASHAs are female honorary volunteers selected from the community and are therefore uniquely placed to provide health and nutritional counselling and services in a complementary manner. Another key figure in the delivery of NHM services is the Auxiliary Nurse Midwife (ANM), whose role is to supervise and guide ASHAs and AWWs in tasks related to the NHM.