Analysis of positive deviance in ICDS

1. Analysis of positive deviance in ICDS Educational Resource Unit Vimala Ramachandran 22 September 2004

2. Specific issues explored • Centre-related: • Targeting of poor households and children under 3 years • Services: location, regularity, activities • Worker related: • AWW and AWH; Supervisory staff • Management factors: • State, district and Block, supply and logistics, monitoring and support, training • Community related: • Interface with community groups, PRI Educational Resource Unit

3. Note! • 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. Educational Resource Unit

4. The findings • Strong, mild and negative processes and outcomes explored with reference to • Workers • Centres • Community • Management • Others Educational Resource Unit

5. Factors explaining positive deviance or lack of itKey findings

6. The human factor • Primary objective as articulated by state leadership: • 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) Educational Resource Unit

7. Targeting of poor • House-to-house surveys, weights (the only growth indicators being used) of 0-6 years, malnourished (grades 1 and 2andgrades 3 & 4) children (We did not find names!) • The following order adhered to: • BPL families • IRDP families • Landless labour or small marginal farmer • ST and SC families Educational Resource Unit

8. The human factor (2) • District and Block functionaries take the cue from the state leadership • Banswara (Raj) DPO proactive • Was PD in Rajasthan WDP – committed and pro-poor • Monthly health-day – closer coordination with health department, • Importance to supply logistics – committee constituted for tenders to supply up to AWC level • Average time-lag of supply after SNP received at Block level is 10 days Educational Resource Unit

9. The human factor (3) • Cluster level (Lady Supervisor) and AWC level crucial • 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 • Garhi a model Block since inception of ICDS • Perceived status of AWW: • 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 Educational Resource Unit

10. The human factor (4) • Notwithstanding; positive deviance found: • Where LS had good rapport with workers, visited regularly • 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 Educational Resource Unit

11. What is a good AWC? • 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. Educational Resource Unit

12. Operational procedures • Lot to learn from Rajasthan – guidelines and operational procedures formulated and communicated, efforts made to iron out contradictions crept in over the years • 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 Educational Resource Unit

13. Lessons • 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. Educational Resource Unit

14. Since SNP is critical… • Ensure adequate and uninterrupted supply • Minimise time-lag: receipt at block & supply to AWC • Cooked meal better than dry & ready to eat • 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; Educational Resource Unit

15. Under 3s • 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 Educational Resource Unit

16. Targeting mothers • 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 • No nutrition education, few tips mentioned in passing • Rajasthan: AWW have FP targets, SHG targets. LS have targets to link SHGs to banks • 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. Educational Resource Unit

17. Growth Monitoring (GM) • Aggregate data given by LS / CDPO • 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 Educational Resource Unit

18. Pre-school education • 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 Educational Resource Unit

19. Convergence • ICDS does not stand alone: • Proactive Sathins and energised education system make people confident to accessgovernment 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. Educational Resource Unit

20. Information flow and monitoring • 15 + registers maintained • 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! • Most important channel is monthly meetings – data submitted • No systems for tracking malnourished children • Put a face to the numbers Educational Resource Unit

21. Community interface • Can potentially make a big difference • 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) Educational Resource Unit

22. What we saw in Garhi Block • Though not part of study sample, visited Garhi (Banswara) - told of “good practices” • 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 Educational Resource Unit