Transcript Analysis of positive deviance in ICDS Educational Resource Unit Vimala Ramachandran

Analysis of positive deviance in
ICDS
Educational Resource Unit
Vimala Ramachandran
22 September 2004
Specific issues explored
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Centre-related:
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Worker related:
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State, district and Block, supply and logistics,
monitoring and support, training
Community related:
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AWW and AWH; Supervisory staff
Management factors:
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Targeting of poor households and children under 3
years
Services: location, regularity, activities
Interface with community groups, PRI
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Note!
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Our aim was to understand the situation we
encountered - positive and negative, analyse why
something does or does not work in a given
environment.
The findings of this qualitative study does not
purport to be an evaluation of the ICDS
programme in the two states.
Views expressed are those of the researchers and
not W Bank or the 2 State Governments.
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The findings
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Strong, mild and negative processes and
outcomes explored with reference to
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Workers
Centres
Community
Management
Others
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Factors explaining positive
deviance or lack of it
Key findings
The human factor
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Primary objective as articulated by state
leadership:
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Emphasis on targeting of poor, SC/ST
Timely procurement and supply of SNP
Fixed health-day
Under-3s – take home rations (No
demonstration to manage grade 3 / 4
malnourished)
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Targeting of poor
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House-to-house surveys, weights (the only
growth indicators being used) of 0-6 years,
malnourished (grades 1 and 2 and grades 3 & 4)
children (We did not find names!)
The following order adhered to:
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BPL families
IRDP families
Landless labour or small marginal farmer
ST and SC families
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The human factor (2)
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District and Block functionaries take the cue
from the state leadership
Banswara (Raj) DPO proactive
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Was PD in Rajasthan WDP – committed and propoor
Monthly health-day – closer coordination with health
department,
Importance to supply logistics – committee
constituted for tenders to supply up to AWC level
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Average time-lag of supply after SNP received at Block level
is 10 days
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The human factor (3)
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Cluster level (Lady Supervisor) and AWC level
crucial
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Dynamic and motivated LS makes a big difference, LS
who worked as Pracheta in WDP were cut above rest
Training of LS and AWW makes a difference
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Perceived status of AWW:
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Garhi a model Block since inception of ICDS
Bottom of the chain, low status, given FP and SHG
targets, participates in campaigns and surveys
Outreach to under 3s limited to immunisation and
health-day only
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The human factor (4)
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Notwithstanding; positive deviance found:
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Where LS had good rapport with workers, visited
regularly
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Residence of LS and AWW important
Where LS and AWW can access Panchayat resources
– hand pump, repair and maintenance of centre,
jaggery, synchronise timings with school
Highly motivated / committed LS can offset
unresponsive / unmotivated CDPO
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What is a good AWC?
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Where village survey completed, poor and
malnourished children enrolled
PSE happens, health day once a month
Record keeping of acceptable level
Relationship between AWW and panchayat
officials is good
SHG groups credits are arranged and utilised
Cooperation between Health and Education
Departments in the block, panchayat, village;
AWW motivation higher than average.
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Operational procedures
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Lot to learn from Rajasthan – guidelines and
operational procedures formulated and
communicated, efforts made to iron out
contradictions crept in over the years
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Location and construction / maintenance
Streamlined SNP procurement, supply logistics
Selection of AWW & “retirement” age fixed at 58
Target beneficiaries fixed, age-group-wise
Weekly menu fixed, distribution 6 days a week
Regular payment of honorarium to bank account
Recognition for good work - awards
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Lessons
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Cohesive guidelines & operating procedures
creates positive environment, minimises
ambiguities and facilitates clarity of roles and
responsibilities among functionaries.
When complemented by motivated and efficient
leaders at state and district levels, it provides
tremendous scope for positive deviance.
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Since SNP is critical…
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Ensure adequate and uninterrupted supply
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Cooked meal better than dry & ready to eat
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Minimise time-lag: receipt at block & supply to AWC
Palatable food a must: link up with Panchayat to
supply jaggery, spices, vegetables (where centralised
procurement problematic) – good practice in Bellary
Arrangements for fuel, cooking space and water
Distribute SNP 2 times – 10.30 and 12.00 –
facilitates better uptake / absorption by children
and ensure children stay for 4 hours;
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Under 3s
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Casual approach to nutrition education to
mothers / care providers
Take-home rations the norm for under-3s,
immunisation done, growth monitoring
done but we could not tally data with real
children!)
Evidence of referrals in Raj – good Block
PHC, resident doctor couple
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Targeting mothers
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SNP distributed to 10 pregnant & 8 lactating
women and 2 adolescent girls in Raj
But AWW do not check if pregnant woman are
registered with ANM for antenatal care
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Rajasthan: AWW have FP targets, SHG targets.
LS have targets to link SHGs to banks
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No nutrition education, few tips mentioned in passing
Poorest women in village not part of SHG – AWW not
interested in them. Focus more on one layer above –
those who have some means to save.
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Growth Monitoring (GM)
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Aggregate data given by LS / CDPO
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This could not be verified in 60 percent of cases!
Weights and names given in registers, no age!
0 to 3 weighed on health-day, same children not
tracked from month-to-month
Data available – but has little meaning as it is
not child specific
No connection between nutrition status and
quantity of SNP, anyone who comes is fed
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Pre-school education
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Rajasthan: recent efforts to give refresher
training in PSE (ex-Shiksha Karmi
Director made in-charge)
No evidence of play-way / child-centered
processes, as yet
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Convergence
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ICDS does not stand alone:
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Proactive Sathins and energised education system
make people confident to access government
programmes. When programme uptake goes up,
pressure on worker to provide services increases.
Converse is also true: ICDS cannot shine by itself if
the health system is dysfunctional, primary schools
over-crowded, teachers indifferent, there is no
independent forum for women to come together and
governance is poor.
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Information flow and monitoring
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15 + registers maintained
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Most important channel is monthly meetings –
data submitted
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AWWs burdened, many pay Rs 100/ a month to
someone to help with record keeping
Most important information, i.e., children grade 2, 3
and 4 malnourished not available by name!
No systems for tracking malnourished children
Put a face to the numbers
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Community interface
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Can potentially make a big difference
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Encountered active / interested SHG,
Panchayat leaders
Did not come across effective mother’s
committee, routine minutes, repetitive month
after month, across AWCs
Women more aware in villages where Sathins
were active (Raj)
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What we saw in Garhi Block
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Though not part of study sample, visited Garhi
(Banswara) - told of “good practices”
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AWW selected and trained pilot phase in mid-1970s
Close inter-flow between ICDS and WDP, LJP also
working in this area (micro-planning), SHG also fairly
active, functioning PHC, TLC was vibrant
CDPO proactive – used relief work to upgrade and
maintain facilities
NGO Vihan providing continuous training inputs
Functioning AWC, food distributed twice, pre-school
education interesting, workers energetic
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