Recent Findings on ICDS and its Performance

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Recent Findings on ICDS and its Performance

• India Nutrition Team, World Bank
• (Summarized from findings shared at the national
  consultation hosted by Bank and MWCD on May 11,
  2006)

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1. The ICDS Program

• Indias primary response to child malnutrition

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Main Finding

• The program is thoughtfully conceived for
  dealing with the major determinants of
  malnutrition in India
• There are MISMATCHES between its intentions and
  actual implementation, therefore it is unable to
  reach its full potential

BUT
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2. The Three Mismatches
OR
The Three Opportunities
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Mismatch IDominant emphasis on food
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40 of time of AWWs is spent to prepare and
distribute supplemental nutrition 30 of time
of AWWs is spent on preschool education-- at
the expense of other ICDS components that are
crucial for promoting childrens growth and
better nutritional status

• Promoting good breastfeeding and complementary
  feeding practices (NHED services)
• Promoting disease prevention and control
  (improving immunization and referrals)
• Providing Micronutrient Supplementation
• Growth monitoring and promotion (only 30 centers
  have weighing scales)
• NCAER Concurrent Evaluation 2001

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Mismatch IILimited reach of the youngest and
the most vulnerable children
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Most growth-faltering occurs by the age of two
Source Regional estimates from Shrimpton et al.
2001 India data from IIPS and ORC Macro 2000
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Yet, participation rates are low among this age
group
Percentage of children of each age group
attending ICDS at least 1/mth
Source ICDS III baseline/ICDS II endline survey
2000-2002
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Insufficient targeting of the poor
Percentage of children of each wealth quintile
attending ICDS at least 1/mth
Source ICDS III baseline/ICDS II endline survey
2000-2002
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Mismatch IIIUneven ICDS coverage
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The five states with most malnutrition are among
ones with lowest ICDS coverage
Source Underweight prevalence calculated from
NFHS II villages covered calculated from NFHS II
data in Das Gupta et al. 2005
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Endline Survey Impact Evaluation of World Bank
assisted ICDS-III/WCD Project 1999-2006

• To assess how far the Project objectives of
  strengthening and improving the quality and
  management of ICDS have been achieved.
• To compare achievements and targets vis-à-vis
  baseline values and also identify reasons for
  non-achievement.
• The findings of the end line survey would also
  provide rationale for development of future
  projects
• (Baseline Survey conducted during 2000)

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States Tamil Nadu (16 blocks), Kerala (21
blocks), Maharashtra (20 blocks), Rajasthan (26
blocks), and Uttar Pradesh (24 blocks)

• Multi-stage Sampling
• Stage I Selection of Blocks Stratified Random
  Sampling
• Stage II Selection of 6-8 AWCs per blocks as
  per population groups Systematic Random
  Sampling
• Stage III Selection of Target Groups 100
  under 3 children, 50
• 3-6 children, 50 Pregnant Women 25 AGs
• 100 AWWs from all selected AWCs
• 44,000 households
• 40,000 Mothers of 0-6 children
• 1,900 Pregnant women
• 8,000 Adolescent girls
• 720 Anganwadi Workers

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Project Development Objective

• Reduction in underweight children of 0-36 months
  by 2 annually in project blocks
• Target About 10 between project effectiveness
  to completion 2000-2005
• Achievement 13.7 (Uttar Pradesh), 9.2
  Maharashtra, 11.4 Tamil Nadu, 4.1 Rajasthan,
  and 3.5 Kerala

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Significant Impact and Process Indicators showing
Positive Changes (End-line Survey versus
Base-Line Survey)

• 1. Malnutrition Status of both under 3 and 3-6
  children
• 2. Incidence of Low birth weight
• 3. Early initiation of breastfeeding
• 4. Colostrums feeding
• 5. Complementary feeding
• 6. Consumption of Vitamin-A rich food
• 7. Receipt of Vitamin-A dose
• 8. Institutional Birth Delivery
• Monthly growth monitoring of under 3 children

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State wise prevalence of Underweight Children
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Communication for behavior negotiation was
initiated
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Growth Monitoring
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Effect of IEC TrainingTwo most important
interventions in the ICDS-III Project
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No Baseline value
Knowledge of transfer from AWW to Target Group is
an area of concern!
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Some Areas for Improvement

• Effective Convergence of ICDS with Health to
  ensure complete ANC of all pregnant women
• Strategizing IEC interventions to remove cultural
  barriers in infant feeding practices, especially,
  in exclusive breastfeeding
• De-worming of children
• IFA supplementation
• Awareness generation on health nutrition issues
  among the target groups
• Specific Training of AWWs for effective service
  delivery

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Registration/Attendance and Growth Monitoring at
AWCs (End-Line Survey)
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Our Concern Is Significant Reform Needed?

• India is justly proud of its major effort in ICDS
• Yet, one key outcome, child undernutrition, is
  not improving rapidly enough
• Can such a large and established program be
  reformed?
• What governmental and civil society approaches,
  what capacities, and what resources are needed to
  bring this about?
• Will ICDS contribute its share to achieving the
  child nutrition MDG in India?