Transcript Nutrition as a national development agenda

Meeting with State
Secretaries
Review of
Integrated Child Development Services
(ICDS) Scheme
28th October 2010
Ministry of Women and Child Development
Government of India
1
PART - I
ICDS : Universalization
2
ICDS: Universalization
• Operationalization :
– Delay in operationalization ( against 14.0 lakh, operational 12.14 lakh
• Target date for operationalisation was September 2010.
• Firm date of operationalisation may be given & ensured !
– ‘Operationalisation’ per se
• States/UTs to ensure
 Adherence to the revised population norm in total- ground verification
 Certification that all habitations are covered
 Upload a list of AWC locations on web sites of States/ UTs
 Full coverage of urban slums/ areas with local innovations
 Address issues of social exclusion
 Optimise coverage of all eligible beneficiaries
3
ICDS : Services
• Supplementary Nutrition Programme (SNP):
• Adoption
of norms
• Implement Revised calorific and cost norms in letter & spirit.
• Morning snack & hot cooked meal for children 3-6 years
• Quantity/ weight of SN per bene. actually given,
• THR for children below 3 yrs and P&L mothers
• Calorific and nutritional norms
• Optimization of coverage: 729 lakh children receiving SN as
against 1195 lakh child (6 – 72 months) population as per AW
survey register
• Quality
• Age appropriate and palatable
• Local nutritious and varied recipes
• Micronutrients !
4
States not conforming to the revised nutritional
norms: deficiencies
Deficiencies:
•
•
•
•
•
•
•
•
Andhra Pradesh (50 Kcal)
Himachal Pradesh (80 Kcal)
Punjab (200 Kcal; 6 gm P)
J & K (200 Kcal; 2 gm P)
Puducherry (200 Kcal; 3 gm P)
Jharkhand (50 Kcal)
Orissa (100 Kcal)
Karnataka (150 Kcal; 3 gm P)
•
•
•
•
•
•
West Bengal (100 Kcal)
Assam ( 500 Kcal; 12 gm P)
A & N Islands (4 gm P)
Uttar Pradesh (50 Kcal)
Kerala (100 Kcal)
Chandigarh (200 Kcal; 3 gm p)
Based on MPR received by FNB, New Delhi
Recent Disruption in SNP
• Assam : No food supplies since Nov 2009
• Punjab : Insufficient ingredients; calorie
• Uttar Pradesh : disruption in HCM; Reduced
ingredients due to price rise leading to low nutritive
values
• Manipur: No feeding provided in 3 centres out of 7
centres visited (June 2010)
• Bihar : Out of 11 units visited in May 2010 only one
provided SNP. In the month of September 14 centres
did not provide any SNP.
SNP : Not as ICDS norms

•
•
•
•
•
•
THR (Hot cooked meal):
Chandigarh
Haryana
Himachal Pradesh
A & N Islands
West Bengal
Phuducherry

•
•
•
•
•
 THR (Dry food grains):
• Goa
• Bihar [target 40 children
(6m-3yrs) for SN, 8
pregnant and 8 lactating
women]
• Jharkhand
States not providing morning snacks :
Puducherry
West Bengal
Bihar
A & N Islands
Chandigarh
ICDS : Services
• Supplementary Nutrition Programme (SNP):
• Micronutrient
fortification : The supplementary food may be
fortified with essential micronutrients (energy and protein excluded)
with 50% of RDA level per ben. Per day
RECOMMENDED DIETARY ALLOWANCES, NUTRIENT INTAKES AND GAPS
Age group 1-3 years
Age Group 4-6 years
Pregnant Women
Lactating Mothers
RDA
Intake
Gap
RDA
Intake
Gap
RDA
Intake
Gap
RDA
Intake
Gap
Energy(Kcal)
1240
687
553
1690
978
712
2175
1654
521
2425
1852
573
Protein (g)
22
18.6
3.4
30
26.5
3.5
65
45
20
75
46.7
28.3
Iron (mg)
12
4.3
7.7
18
6.8
11.2
38
12
26
30
11.8
18.2
Vitamin A (mcg)
400
56
344
400
66
334
600
111
489
950
107
843
Calcium (mg)
400
161
239
400
66
334
1000
352
648
1000
320
680
Thiamin (mg)
0.6
0.4
0.2
0.9
0.6
0.3
1.1
1.0
0.1
1.2
1.2
0
Riboflavin (mg)
0.7
0.3
0.4
1.0
0.3
0.7
1.3
0.5
0.8
1.4
0.6
0.8
Niacin (mg)
8.0
4.7
3.3
11.0
7.4
3.6
14.0
12.4
1.6
16
14.4
1.6
Vitamin C (mg)
30
9
21
40.0
15.0
25
40
26
14
80
28
52
Free Folic Acid
(mg)
30
18
12
40
26
14
400
48
352
150
53
97
HCM: leafy veg;
THR:
through GMP( manufacturers); Fruits.
Sprinkler: NO;
Sachet: ? ( only in centralised and monitored kitchens !)
8
ICDS : Services
• Supplementary Nutrition Programme (SNP):
• Management
• Supply chain
- commodity management
- uninterrupted distribution at AWC
• Regularity and timelines
• Adopt normative approach and reduce wastage
• WBNP:
•
States/ UTs to give basis and details of requirements of food grains
urgently
• Rationale for not availing food grains
• Capacity Building & Social Mobilization
• Supervision and monitoring
• Mothers’ group and community monitoring
9
ICDS : Services
• Pre-School Non-formal Education:
• Ensure availability of PSE kits
• Usage of Local materials & effective communication
• Methods used for joyful learning and improve Quality
• Optimize coverage of children (3-6 years) for PSE
• Ensure PSE activities on regular basis at all AWCs
• Assess and ensure school readiness (Section 11 of RTE) &
Leverage resources for strengthening ECE; Linkage and
leverage with RTE
10
ICDS : Services
• Weighing
& Growth monitoring
• Arrangement for procurement of weighing
scales
• Roll out of WHO Growth standards – Timeline
by which implemented
• Adoption of joint mother and child protection
card
11
States not following the WHO
norms for Growth Monitoring
•
•
•
•
•
•
•
•
Goa
Chandigarh
Tamil Nadu
Andhra Pradesh
Kerala
West Bengal
Bihar
Orissa
•
•
•
•
•
Manipur
Sikkim
Arunachal Pradesh
Delhi
Rajasthan
ICDS : Services
• Health and Nutrition Education:
• Joint home visits
• Training
• IEC and campaign – Observation
13
ICDS : Services
• Coordination & Convergence:
• Health:
•
•
•
•
- Effective arrangement for health related services at AWCs
Immunization
Supply of IFA tablets and Vitamin “A”
Health check ups and referrals
Management of severally undernourished
- Reflect ICDS related services separately and categorically in
NRHM PIPs at all levels
- Holding of VHND
- Institutional arrangements for effective engagement of health
sector
• DDWS:
- Provision of safe drinking water
-Provision of child friendly toilet
- Awareness on sanitation and safe drinking water
14
ICDS – Infrastructure
Three
CMU Decades of Average
ICDS
S. No
Indicator(s)
NCAER
1
Ownership of AWC Buildings
- Own building/State Govt.
42.5
27
28.5
32.67
17.3
17.4
22.9
7.2
28.1
36.9
33.2
19.7
15.9
19.23
21.73
25.23
9.4
20.8
69.2
0.6
23.9
75.4
0.7
16.65
20.80
72.30
0.65
48.4
44.5
48
50.3
50.67
50.77
- Primary school building/ Provided by
Community free of Rent
- Rented building
- Others
2
3
Facilities & Infrastructure available at AWCs
- Kuccha Buildings
- Semi-Pucca Buildings
- Pucca Buildings
- Open Space
AWC's having Separate Space/ Adequate
Space
- For Cooking
- For Storage
55.6
57.5
15
ICDS – Infrastructure (contd..)
S. No
4
5
6
7
8
Indicator(s)
Three
Decades Average
of ICDS
NCAER
CMU
71.8
38.5
68
66.8
47.9
51.3
51.5
41
39.77
63.37
42.47
28.4
58.8
12.9
37.4
42.2
20.4
44.1
43.3
3.2
36.63
48.10
12.17
48.3
49
73.4
75.6
60.7
61.8
60.80
62.13
68.9
83.8
77.4
AWC's having Adequate Space
- For Outdoor Activities
- For Indoor Activities
Available with Toilet Facility
AWC’s with Water Sources
- Tap/ Piped Water
- Hand Pumps
- Others
Avalability of Utensils
- For Cooking
- For Serving
Available of Weighing Scale
- Weighing Scale available & Functional
76.70
16
ICDS – Infrastructure (Contd…)
• Construction of AWCs Buildings
• Tap MPLADS, MLALADS, BRGF, RIDF, PRI, State Plan including ACA,
MSDP, BADP, etc for AWCs buildings
• Construct good model buildings with full amenities
• Provide adequate space, other facilities and equipments
• State/UTS were requested to submit Action plans for strengthening
quality of infrastructure at AWCs by September 2010.

States may send immediately after due diligence.
17
• Vacancies:
ICDS: Management
Manpower
– Large vacancies at all levels in almost all States
– Timeliness to fill up vacancies at all levels
[10% deduction from grant if vacancies of Supervisors , AWW s &
AWHs 40% or more; 20% deduction if 50+%? ]
• Promotion:
– AWW to Supervisor
– AWH to AWW
• Dedicated cadre
• Tenure stability
• Disengagement of ICDS functionaries from non- ICDS
related activities [10% deduction from grant if? ]
18
ICDS: Management Issues
• Fund flow mechanism
• Timely payment of honoraria: mechanism to be put in
place
• Motivation
– Additional honoraria by state
– Insurance coverage of LIC & other benefits
– Proposed Rastriya Swasthya Bima Yojana (possible sharing
75:25)
– Proposed pension scheme (Quantum of State share say 1000 per
anum / per benef.)
19
ICDS: Management Issues
• Community Participation
• Replication of Best practices
• Effective monitoring
• Training:
• Cross sectoral, horizontal and vertical integration of training
both in content and participation; circular trg. intrasector/ intra
project and inter project
• Make STRAP a meaningful exercise . Send proposal for 201112 by January 2010.
• State level Task Force
• Peer group
20
WBNP
• States/ UTs not taking food grains during 2010-11:
Assam, Delhi, Sikkim, Puducherry, Chandigarh, Lakshadweep and
Daman & Diu
•Wheat @ Rs4.15 per Kg; Rice @Rs5.65 per Kg. Whereas
market rate – Wheat: Rs 12 – 15; Rice: Rs 15 – 20
• Rs 4 for SNP will fetch all most a Kg of wheat and about 800 gms of
rice; whereas at market rate it fetches about 250 – 300 gms of wheat
and rice.
•States/ UTs furnished information regarding the basis of
requirement of food grains: Meghalaya, Bihar and J&K to furnish
revised information which is still awaited. Information from Dadra &
Nagar Haveli not in prescribed format
• Total requirement in MT per annum = (SNP grains (in gms) X No of
beneficiaries X 300 days)/ 10 lakh
• The quantum of food grains would vary on the composition and component of
food grains
21
WBNP
• Statement indicating on Requirement, Allocation &
Lifting (in MTs)
Years
Requirement
Allocation
Lifting
2008 – 09
1,018,084
729,100
666,968
2009 - 10
1,168,831
967,584
757,310
2010 - 11
16,13,044
10,50,734 (till
3rd quarter)
1,88,261 (till
June 2010)
• States/ UTs lifted below 50% allotment (2009-10):
Uttarakhand, Manipur, Maharastra, J & K, DN & Haveli, Arunachal
Pradesh
For 2011-12, allocation of foodgrains to States/ Uts will be made
who have lifted lifted 70%+ of the foodgrains allotted so far
(including revalidated quantities)
22
ICDS: Monitoring
• State level consolidated MPR in Format I & II to be sent
regularly
• Monitoring officer held responsible. Late submission of
these reports may withhold salary of concerned
monitoring officer
• MIS being revised at all levels. Field testing in 6 states; in
6 blocks. Revised records & registers at AWCs and
MPRs/ ASRs being implemented from 1.4.2011
• Web based MIS being developed by NIC on revised MIS..
23
ICDS: Monitoring contd…
• CMU, NIPCCD in operation since 2009-2010. Medical
Colleges, Home Science Colleges and School of Social
Science involved in monitoring and supervision of ICDS
• Proposal to revise monitoring committees at all levels
• Check list for field visit for monitoring and supervision
finalised.
• Proposal to involve National Level Monitors (NLMs) rtd
civvil servants and defence personnels.
24
Draft Findings of Evaluation of ICDS
by NCAER (2009)
• Planning Commission during 2009-10 directed the
National Council of Applied Economic Research
(NCAER), New Delhi.
• a sample of 19,500 households, 3,000 community leaders
and 1,500 AWCs from 300 ICDS Projects across 35
States/UTs that were set up before March 2005.
• The draft Report of the evaluation study
Components of Facility Index (FI)
Components
Max
Average
AWCs housed in owned buildings (%)
92.6 (Chh)
43.8
AWCs with adequate space for cooking (%)
92.6 (TN)
59.9
AWCs with adequate space for storage (%)
91.8 (TN)
59.8
Mean area of room in AWC (Sq Ft)
404.0 (Rajasthan)
299.8
AWCs having toilet with flush system (%)
60 .0 (TN)
15.6
AWCs having drinking water facility within
premises (%)
88.1 (MP)
62.7
AWWs attended training (%)
100.0 (AP, Har,
Raj, Jha)
82.8
AWCs with functional weighing scale of
children (%)
95.5 (TN)
73.7
AWCs having adequate toys (%)
89.9 (HP)
37.1
AWCs having adequate posters (%)
94.2 (Uttarakhand)
57.0
AWCs having adequate PSE kits (%)
90.1 (HP)
47.1
AWWs whose education above middle
school (%)
98.1 (Uttaranchal)
80.8
27
Mean SD and CV of the Indicators used for
Composite PI
Indicators
Max
Average
Average number of days received food
21.0 (Haryana, Karnataka,
Maharashtra, Orissa, TN,
WB)
16.9
Percentage of children (12-23 months)
fully immunized
86.7 (TN)
58.9
Percentage of Children able to Write
alphabets/words among those attending
PSE
82.3 (Assam)
53.2
Percentage of women reporting attended
NHE meetings
72.1 (Kerala)
27.9
Percentage of mother reporting seeking
help from AWW when their child gets
sick
28.5 (Andhra Pradesh)
11.2
Percentage of mother reporting received
deworming tablets from AWC
92.8 (Madhya Pradesh)
59.9
Average attendance (number of children
aged 3-6 years) based on 3 sudden
visits by NCAER
28
20 ( Madhya Pradesh,
Maharashtra)
13.6
Behavioral Changes and Outcome
ICDS aims at bringing about behavioral changes w.r.t.
sanitation, hygiene, seeking education & health services,
dietary habits etc. through NHE, PSE.
Findings:
– Intended changes of varied intensity observed in-Kerala, HP,
AP, TN, Maha, WB, Jharkand.
– Bihar, UP, Raj, Haryana, Pun ranked low.
– Practice of BF within an hour of birth is more common among
ICDS participants.
– School enrollment more and early discontinuation less
among ICDS beneficiaries.
– ICDS has made no significant difference in immunization
rates.
29
Theory of change issues in ICDS:
Program Restructuring
Hierarchy
Causal chain-ICDS
Impact
Reduced mortality,
Increased weight for age in
children
Outcome Awareness, Behavioural
changes in: hygienic/dietary
habits, health/education
seeking behaviour
Output
Effective coverage, Quality
of delivery of SN, PSE/NHE
Activities Surveys, Coverage,
Organising delivery of
food/ration, PSE/NHE,
Immunization etc.
Input
AWC infrastructure, Funds,
Materials, Human resources
30
Observations-general
Impact conditional on Effective
Coverage, AWC performance, quality
spending, convergence of services.
Influenced by infrastructure, human
resources, convergence of interrelated
services, quality delivery of services.
Influenced by quality of spending,
infrastructure, human resources
Affected by infrastructure,
overburdened/underpaid AWC;
Monitoring weak; more emphasis on
Record-keeping, data unrepresentative.
AWC not equipped, AWW –vulnerable,
not trained & motivated, inadequate &
untimely input;
Summary Findings
A. Coverage of target groups – Children
• 49% of the size of the eligible group
(vide census) are actually registered for
ICDS benefits.
• At the national level, of those recorded in
the delivery register for ICDS benefits:
– 64% received Supplementary Nutrition (may not be for all 300
days), immunization and other benefits,
– 12% received other benefits but not supplementary nutrition and
– 24% have not received any benefits;
Coverage - Continued
•
The proportion receiving all ICDS benefits varies across States:
High Performers: More than 70% of the children receiving supplementary
nutrition out of the total children recorded in the delivery register (not
necessarily as per norms) are:
Andhra Pradesh, Assam, Chhattisgarh, Gujarat, Himachal Pradesh, Jammu
& Kashmir, Jharkhand, Karnataka, Kerala, Tamil Nadu, Uttarakhand and
West Bengal.
•
Low Performers: Bihar (53%), Haryana (52%), Rajasthan (56%) and Uttar
Pradesh (41%), Punjab (59%).
Infrastructure
A. AWC Buildings:
• Overall 42.5% of sampled AWCs have their own buildings, 17.4%
are in rented buildings, 17.3% are located in primary schools and other
22.9% are running from AWW/AWH house, panchayat and community
buildings.
• More than 60% AWCs run from their own buildings in the states of
Tamil Nadu (85.6%), Chhattisgarh (92.6%), Assam (69.6%),
Maharashtra (68.5%), Karnataka (65.3%), Kerala (65%) and Gujarat
(61.5%).
• Space for indoor activities was found to be adequate in most AWCs
(71.8%). Almost all States had similar dimensions of the AWC
buildings.
• Average room area: 315 sq ft (average length : 20 ft, breadth: 15 ft),
lowest being reported in Himachal Pradesh and J&K (160 sq ft).
Infrastructure – Contd/
B. Drinking Water facility at AWCs:
Country-wide, a
total of about 87% AWCs (58.8% with hand-pump, 28.4% with pipe water
facility) were found to have drinking water supply.
C. Sanitation Facility at AWCs:
About half the AWCs
across the states had toilet facilities in the premises. However, most AWCs
(about 80%) in Bihar, UP and Orissa were without toilets.
D. Equipments/Kits at AWCs: 69%
of sampled AWCs
having functional baby weighing scale; 49% of AWCs having utensils; 48% of
AWCs having cooking vessels; only 44% of AWCs having PSE kits and 62% of
AWCS having medicine kits.
E. Overall Infrastructure Index (20 major States):
•
•
Top 5 States: Tamil Nadu, Kerala, Maharashtra, Andhra Pradesh and Gujarat
are ranked as top five states
Bottom 5 States: Rajasthan, UP, Punjab, J & K, and Bihar
Service Delivery
•
82% of AWWs reported to have been involved in other government schemes
during the last year with an average no. of days spent as 14 with 6 hrs/day.
(Table 6.12 pp-64)
•
Only 41.2% AWCs reported to have updated child growth chart (Table 6.16)
•
93.6% of sampled AWWs reported to have been adequately trained to
conduct PSE (Table 6.17)
•
Average visits made to AWC in six months: By Supervisors - 5 visits; By
CDPOs – 1 visit. Their main focus during the AWC visits has been record
keeping (pp-76).
•
About 40% of AWWs reported getting some help from Panchayat with about
36% in monitoring and 34% in providing infrastructure (pp-83)
•
31% AWWs reported getting help from Village leaders/Committee with 41%
in monitoring and 26% in providing infrastructure (pp-84)
Service Delivery – Contd/• About 70% of the community leaders felt that the ICDS
programme was very useful to the community (pp-102);
• 51.2% children (12-23 months) were found to be fully
immunized (pp-121);
• 49% of children were observed to be able to write
alphabets/ words;
• Only 24% women reported to have attended NHE
meetings;
• Average attendance of no. of children 3-6 yrs based on
three sudden visits by the Research Team was found to
be 14 (pp-121);
Programme Outcomes
• Intended behavioral changes of varied intensity observed in Kerala,
Himachal Pradesh, Andhra Pradesh, Tamil Nadu, Maharashtra, West
Bengal and Jharkhand; Bihar, Uttar Pradesh, Rajasthan, Haryana
and Punjab ranked very low in terms of intended behavioral changes
among ICDS beneficiaries.
• In general, the practice of breast feeding within an hour of birth is
found to be more widespread among ICDS beneficiaries;
• ICDS has positively influenced formal school enrolment and
reduction in early discontinuation among beneficiaries;
• At the national level, ICDS programme has impacted the
immunization coverage, specially measles vaccination (Table 8.9).
• There is no significant difference in the nutritional status among
children 7-60 months between ICDS and non-ICDS populations
(Table 9.2, pp-146)
Changes Required for Better Performance
• Universalization Vs resources
• Job security and compensation of AWW
• AWC infrastructure
• Convergence of complementary services
• Monitoring and verification of office records
• Revision of per capita norms in keeping with inflation
38
Ranking of States : Overall Performance in ICDS
•
Based on seven indicators:
–
–
–
–
–
–
–
Ave. no. of days SNP received in last 3 months,
% of children 12-23 months fully immunized,
% of children who are able to write alphabets/words,
% of women reporting NHE meetings,
% of mothers reporting seeking help from AWW when their child gets sick,
% mothers reporting received deforming tablets from AWC, and
Ave. attendance of 3-6 year old (based on 3 visits by NCAER)
•
Top Six States: Karnataka, Maharashtra, Andhra Pradesh, West Bengal,
Jharkhand and Tamil Nadu
•
Bottom Six States: Punjab, Uttarakhand, Rajasthan, UP, Assam and Bihar
PART - II
ICDS : Restructuring
40
ICDS: Restructuring
• ICDS Restructuring – redesigning ICDS objectives, services and
outcomes
• Implementation in flexible mode – different models and institutional
arrangements for delivery of services
– States/ UTs had to submit successful models by August 2010 after
stakeholders consultation at various levels & validation [still pending]
• Key focus
– Reduction in undernutrition; children < 3 and maternal child nutrition
– Early Childhood Care and Education
• Strengthening AWC platform as a comprehensive village care centre
for young children, mothers & adolescent girls
• State /District PIPs with accountability for nutrition and early learning
outcome
• Discussions and Suggestions
41
Mother & Child Protection Card
42
THANK YOU
43