Ministry of Women and Child Development Government of India

1. Meeting with State Secretaries Reviewof Integrated Child Development Services (ICDS) Scheme28th October 2010 Ministry of Women and Child Development Government of India 1

2. PART - I ICDS : Universalization

3. 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

4. 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 !

5. 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

6. 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.

7. 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

8. 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 • HCM: leafy veg; THR: through GMP( manufacturers); Fruits. • Sprinkler: NO; • Sachet: ? ( only in centralised and monitored kitchens !)

9. 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

10. 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

11. 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

12. 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

13. ICDS : Services • Health and Nutrition Education: • Joint home visits • Training • IEC and campaign – Observation

14. 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

15. ICDS – Infrastructure

16. ICDS – Infrastructure (contd..)

17. 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.

18. ICDS: Management Manpower • Vacancies: • 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? ]

19. 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.)

20. 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 2011-12 by January 2010. • State level Task Force • Peer group

21. 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

22. WBNP Statement indicating on Requirement, Allocation & Lifting (in MTs) 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)

23. 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..

24. 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.

25. Draft Findings of Evaluation of ICDS by NCAER (2009)

26. 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

27. Components of Facility Index (FI)

28. Mean SD and CV of the Indicators used for Composite PI

29. 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.

30. Theory of change issues in ICDS: Program Restructuring

31. Summary Findings • 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;

32. 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%).

33. 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).

34. 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

35. 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)

36. 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);

37. 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)

38. 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

39. 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

40. PART - II ICDS : Restructuring

41. 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 ICDS: Restructuring

42. Mother & Child Protection Card

43. THANK YOU