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ICDS in Delhi A Reality Check - Right to Food Campaign

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					                ICDS in Delhi:
                A Reality Check
          Prepared by Delhi FORCES
                                    (Neenv)

                                         Foreword


This study is an outcome of a lot of dedicated work and thinking by a team of persons
from different fields and organizations (Neenv), committed to making a difference in the
lives of young children. Even though the ICDS programme has been in position for the
last 30 years, field experiences showed that there was little or no evidence of its
existence nor was there any awareness about the programme amongst the people.

The study was planned to assess the ground reality in a focused way so that it could
then serve as an important advocacy tool to lobby with the Government as also
generate an interest on the issue amongst the stakeholders.

In fact during the interface with all the stakeholders for data collection itself, the process
of creating interest was initiated. This was subsequently sustained through the follow-up
awareness campaigns and as part of the Bal Adhikaar Yatra in November-December
2006.

This is just a beginning and we hope that this well designed meticulous piece of work
will be used to fulfill address the mandate for which it was created.


Mridula Bajaj
Convenor
Delhi FORCES (Neenv)
                                CONTENTS


1.    Preface                                                           1
2.    Abbreviations                                                     4
3.    Executive Summary                                                 5
4.    Chapter 1: ICDS and Our Children                                  10
5.    Chapter 2: The Study                                              12
6.    Chapter 3: Findings of the Study                                  15
7.    Chapter 4: Role of Functionaries and Issues Pertaining to their   27
      Role
8.    Chapter 5: Role of the Community and their Participation          32
9.    Chapter 6: Conclusion                                             35
10.   Bibliography/References                                           38
11.   Annexures                                                         39




                                         1
PREFACE
National FORCES came together in 1989 to focus attention on the most critical years of
the child, between 0-6 years and advocate for childcare services for poor women
working in the unorganised sector. The network comprises of research and academic
institutions, women’s organizations, trade unions and grassroot NGOs working in Delhi
slums with focus on health, urban services and child rights issues. Under the
convenorship of Mobile Crèches, the National Secretariat of FORCES from 1996 to
2001 felt the need to develop a Delhi chapter and Neenv emerged out of this exercise in
2002. Working with diverse groups in Delhi and with National FORCES, Neenv has
established itself as a strong advocating network for the rights of the young child in
Delhi.


All member organizations of Neenv felt that there was a need to be equipped with data
on the status of the young child in Delhi, particularly, on the question of access to, and
quality of services available for children. As a Network, it recognised that the case for
Early Childhood Care and Development had to be built on sound evidence, technical
knowledge and would require interaction with the political and state establishment. The
Study on ICDS in Delhi was thus planned to strengthen the hands of grassroot
advocates to raise the issues of children’s entitlements, their access to services and the
issue of quality necessary to bring about change.

This study would not have been possible without the support of Ms. Rashmi Singh,
Director, ICDS and Mr. Anil Agarwal, Deputy Director, who accorded us permission for
carrying out the study. We would also like to extend our heartfelt thanks to all CDPOs,
MOs, Supervisors, ANMs, Anganwadi Workers and Anganwadi Helpers, for their active
interest, patient listening and participation in our meetings and discussions. All of them
have contributed substantially with their valuable insights and inputs.


We gratefully acknowledge the contributions of Mr. Surendra Pal Ratawal, MLA, Karol
Bagh and Ward Councillors from different parts of Delhi.          We express our deep
appreciation towards the patient cooperation of mothers of the child beneficiaries of
AWCs who never said no, be it answering our long questionnaires or participating in
community meetings or six consecutive visits to their homes for case studies.




                                             2
Grateful thanks are due to Oxfam India, the donor organisation for financially supporting
the study.


This study would not have been complete but for the untiring efforts put in by the
committed team of consultant, coordinators and research investigators – Devika Singh,
Hemlata Kansotia, Sudeshna Sen Gupta, Kanwaljeet Virdi, Jyoti Sinha, Abishak, Tultul
Hazra, Sheetal, Rajender Kumar, Sajida Khanam, Madan Lal, Mohd. Gulzar and
Sawan Kumar Suman. We extend our gratitude to all our member organisations for their
cooperation and inputs in making this year long effort successful.

A special thanks to Mobile Crèches for extending full cooperation and support for this
very useful exercise.

                                                   Neenv, Delhi FORCES
                                                  Date: Nov. 2007

Partners who were directly involved in this year-long exercise includes:

Mobile Creches – Convenor
EFRAH – Co-Convenor
Nirmaan – Co-Convenor
Alamb
Navshristy
Bhalaswa lok shakti manch
Ashray
Abhiyuday
Action Community and Training
Bal Vikas Dhara
Chetana Welfare Society
Dr. A. V. Baliga Memorial Trust
Initiative for Social Upliftment (ISU)
Jeet
Labour Education and Development Society
M.T. Bavjyoti Development Society
Navsrishti,
Sarthak Yuva Kendra
Sathee
Savera
SEWA
Sneh Bandhan Society
Social Action and Training
Surakshit
Jhuggi Jhpori Ekta Manch
Mahila Kalpana Shakti
Women and Children Upliftment Programme (WACUP)
Prerana Mahila Sangathan




                                            3
Abbreviations used in this Report


ANM           -       Auxiliary Nurse Midwife
AWC           -       Anganwadi Centre
AWH           -       Anganwadi Helper
AWW           -       Anganwadi Worker
CDPO          -       Child Development Project Officer
CIRCUS        -       Citizens Initiative for the Rights of Children Under Six
CMR           -       Child Mortality Rate
ECCD          -       Early Childhood Care and Development
FOCUS         -       Focus on Children under Six
ICDS          -       Integrated Child Development Services
IMR           -       Infant Mortality Rate
MLA           -       Member of the Legislative Assembly
MO            -       Medical Officer
MWCD          -       Ministry of Women and Child Development
NFHS          -       National Family Health Survey
NGO           -       Non-Government Organizations
NHE           -       Nutrition and Health Education
NSSO          -       National Sample Survey Organization
PHC           -       Primary Health Centre
SNP           -       Supplementary Nutrition Programme
UFMR          -       Under Five Mortality Rate
UP            -       Uttar Pradesh
WCD           -       Women and Child Development




                            EXECUTIVE SUMMARY
The Integrated Child Development Scheme (ICDS), is the only programme for the under
sixes offered by the Government. Hence, it was important for Neenv, a hardcore grass-
root network advocating for the under sixes, to find out how the programme is
performing on the ground level.




                                              4
The Study on Status of ICDS in Delhi was thus planned with the broad objective of
looking into the performance of ICDS in the city of Delhi with respect to infrastructure,
coverage, distribution of supplementary nutrition, health and pre-school education and
to understand the linkages of health, drinking water and sanitation facilities from the
perspectives of the functionaries and beneficiaries.


The study was conducted using different methods viz. questionnaires, interactive
surveys, one-to-one interviews, focus group discussions as well as non-participatory
observations. The interactions between data collection team, Neenv partners and
communities have yielded valuable insights on the status of ICDS in Delhi


Out of a total 28 ICDS projects in Delhi 27 were covered. 242 Anganwadis were
covered during the study. About 2970 beneficiaries and functionaries were surveyed
using questionnaires, 11 Focus Group Discussions were conducted and also a one-to-
one interview with one MLA (although it was decided to meet three MLAs but only one
gave an appointment). Ten children were followed for six months which constitute a
significant source of information as case studies. The completion of the study took two
years.


Findings:
Some of the major findings are as follows:


Infrastructure
        Centres suffer from inadequacy of space, low and irregular payment of rent,
         inadequate arrangement of drinking water and toilets and scarcity of equipment
         like weighing machine, teaching aids etc.


Coverage
        There is a glaring contrast between the enrollment recorded in the registers of
         AWCs and the number of children actually found attending.
        The surveys by AWWs are irregular. There are centers where no survey has
         been carried out for more than three years consecutively.


Exclusion


                                             5
Exclusion is becoming an issue of great concern. The Supreme Court in the decision of
13th December 2006 drew special attention to it. In this context, exclusion of a range of
vulnerable children from ICDS in Delhi is a matter of utmost concern.
      Children with disability are not found registered in any of the AWCs surveyed in
       Delhi
      Children of rag-pickers, construction workers, migrant labourers, street children
       and homeless children are left out.


Supplementary Nutrition Programme
      The food does not reach the centres in time and the quantity distributed is not
       fixed.
      Irregularity in the distribution of SNP was observed.
      76% beneficiaries share the food with family members.


Health and Nutrition
      Only 17% AWCs had records on malnutrition
      Only 25% children below six years and .9% pregnant women are weighed (as
       per beneficiaries’ survey).
      Discrepancies in the data related to immunization and weighing were found.


Monitoring and Supervision
      66% AWWs said the CDPO had not visited the centre in the last six months.
      Low participation in pre-school activities.
      No maintenance of children’s growth chart and absence of records of children
       with malnutrition have all gone unnoticed and unattended.
      Supervisors are used for election and other duties which interfere with the entire
       system of monitoring. Supervisors are also given responsibility of two, and
       sometimes three projects, making supervision almost impossible.




Human Resource
      The AWW does not enjoy an employee status. She is hired on an ad hoc basis
       and receives a fixed honorarium.


                                             6
        There is no security of job. The payments do not come regularly. These factors
         affect the morale of the workers and quality of services.


Participation of Community and Leaders
        6% AWWs have said that MLAs have visited the centre and only 10% said they
         had received support from the Pradhans.
        Only 40% AWCs received support and help from the beneficiaries. Parents are
         largely unaware of the objectives and services of ICDS.
Based on the above, a list of recommendations was drawn up which focus on essential
actions that are required to improve the quality of the services and to ensure that basic
entitlements and needs of young children are met.


Recommendations:
i.   Infrastructure:
        Norms: Norms for infrastructure should be specified and based on the space
         required for activities, storage, kitchen, independent toilet. Availability of drinking
         water must be compulsory.
        Rent Allocation and payment: Rent allocation must be adequate to cover cost of
         the above specified space in urban areas. Regular payment of rent is absolutely
         necessary to save AWWs and Supervisors from harassment.
ii. Supplementary Nutrition Programme and Malnutrition:
        Allocation and Utilisation: To intervene in malnutrition of young children, both
         issues of allocation and spending needs to be addressed. Government of Delhi
         has spent Rs. 0.52 per day per beneficiary (as per Delhi government’s estimate
         for number of children receiving SNP in the month of May 2006) which is far
         below central norms of Rs. 2 per day per child.
        Distribution of SNP: It is recommended that distribution of SNP takes place at
         fixed time mutually convenient to AWW and beneficiaries, every day in the
         prescribed quantity. To meet nutrition targets, it is recommended that
         beneficiaries eat at the centre so that food is not shared with the family, as found
         in a large number of cases.
        Special intervention for children with malnutrition: All children with malnutrition
         must be given double rations and for those in Grade III or IV, medical
         intervention must also be provided.
        Awareness: Nutrition awareness for families is strongly recommended.
                                               7
iii. Health and Nutrition Monitoring:
      Growth Charts: Weight must be taken on a monthly basis for children under
       two years and on a three monthly basis for all the rest as per norms. Growth
       Charts for all children must be maintained
      Monitoring and Supervision of Records: Records of growth charts, malnutrition
       interventions and immunization need to be carefully kept, supervised and
       monitored.
      Capacity building and awareness: AWW’s capacity to keep accurate records
       must be developed and families made aware of the importance of accurate
       records. Quality control of nutrition and health can be brought about by involving
       Mahila Mandals and AWWs should be required to monitor participation and
       enhance attendance of community at meetings.
iv. Pre-School Education:
      Space: AWCs must have adequate space for pre-school activities to be carried
       out for 40-50 children.
      Two Worker Model: AWCs need a worker trained to focus on pre-school needs
       of 3-6 age groups. This necessitates a second worker to address health and
       learning needs of under 3’s registered with the AWC.
      Rights Framework: The legal framework for the under 6’s must be strengthened
       by bringing the ECCD under the Fundamental Rights Section of the Constitution
       by ensuring adequate budgets and systems.
v. Disability
      Inclusion: Inclusion of children with disability in surveys and their registration
       should be clearly spelt out in the guidelines.
      Training for Inclusion of children with disability: AWW’s training programmes
       should have comprehensive inputs on disability.
vi. Monitoring, Supervision and Support:
      Regularity, Feedback and Action: CDPOs, Supervisors, need to monitor AWCS
       regularly and providing feedback on reports and support for problem solving.
       Records need to be checked and action taken for reports without proper
       information.
      Follow Norms of Supervision: The number of centres to be supervised should be
       in accordance with norms. When the number of centres to be supervised
       exceeds norms, supervision is ineffective.


                                            8
      Community Support and Supervision: To strengthen this vital component it is
       recommended that a well thought out programme of awareness by interest,
       need and participation of community be institutionalized. A dedicated budget
       should be allocated for the above.
vii. The Anganwadi Worker:
      Employee Status: Employee status for the AWW along with regular payment of
       honorarium. This will boost the morale of AWWs and improve the quality of
       services.
viii. Community Participation: Community leaders as well as community in general,
   should be mobilized to take the quality issue of AWCs on as part of their political
   and social agenda. It is preferable to have NGOs acting as pressure groups and not
   act as implementers of programmes.




                                            9
                                           Chapter 1
                                       ICDS and Our Children
1.1 INTRODUCTION
The Integrated Child Development Services (ICDS) Scheme was conceived in 1975
with an integrated delivery package of early childhood services. It is the only major
national programme that addresses the needs of children under the age of six years.
The Scheme aims to improve the nutritional and health status of vulnerable groups
including pre-school children, pregnant women and nursing mothers through providing a
package of         services including          supplementary nutrition,            pre-school education,
immunization, health check-up, referral services and nutrition and health education. The
programme provides an integrated approach for converging basic services through
community-based Anganwadi workers and helpers.

As per 2001 census, India has around 157.86 million children, constituting 15.42% of
India's population, who are below the age of 6 years. Of these 157.86 million children,
75.95 million children are girls and remaining 81.91 million children are boys. The sex
ratio among children (0-6 years) as per Census 2001 is 927 i.e. 927 females per 1000
males. The investment in ICDS has been growing. In the 10th Five Year Plan (2002 –
2007) it was Rs. 116845 million against an expenditure of Rs. 26012.8 million in the 8th
Five Year Plan (1992-1993 to 1996-1997). Despite this huge expenditure and
Government of India’s commitment for children at national as well as international fora1,
the following facts about the status of the children in India indicate the pathetic condition
of the children. One out of sixteen children die before they attain one year of age


        One out of 11 dies before they attain five years of age.
        One in every three malnourished children in the world lives in India.
        79% of our children suffer from anaemia.
        Sex selective abortion has brought down the sex ratio to an alarming ratio of
         1000 boys is to 927 girls for the 0-6 age group
        Around 33% of the total number of children have an access to ICDS the major
         government program for the young child
        Only 46% children breastfed within an hour of birth
        56% of 12-23 month year olds are not fully vaccinated
        35% of children have birth registration
    Source: Status of Children in India Inc – HAQ and Centre for Child Rights and FOCUS Report




1
 India has ratified Convention for the Rights of the Child way back in 1992. Our Constitution and National Plan of
Action articulates our intentions of putting children first, but the reality is as above.

                                                       10
1.1.1 Children in Delhi and ICDS:
Delhi, the capital city of India, is one of the fastest growing states in terms of economy.
The per capita income of Delhi is 2.5 times the national average and in economic terms
it is one of the most developed parts of the country. Though Delhi is projecting itself as
a world class city with shopping malls, metro rails and super facility hospitals, it suffers
from problems of rapid urbanization, heavy migration and a proliferation of unauthorized
slums all of which affect the status of children. NFHS-III data reveals high IMR, CMR
and poor outreach of the services for the under sixes. (See table-1)


Table 1: Status of Young Child in Delhi
% of children covered by ICDS                                           24
IMR                                                                     40
CMR                                                                     83
% of children suffering from malnutrition                               33
% of children suffering from anaemia                                    63
Children born underweight                                               30
% of children covered by Vitamin A Supplementation                       17
% of children exclusively breastfed for first 5 months                   34
Source: NFHS III, 2003

In addition to the concerns on the poor health status of young children, the issue of lack
of child care support services for women is also a major concern, particularly for
families who have been moved out to the periphery of the city and those who live in the
slums.




                                                11
                                        Chapter 2
                                        The Study
2.1 OBJECTIVES OF THE STUDY:
     To assess the performance of ICDS in the city of Delhi with respect to its service
      delivery components.
     To understand the challenges faced by functionaries like AWW, Supervisors and
      CDPOs and their roles and responsibilities impacts the effectiveness of the
      programme.
     To find out the level of participation of the community in this major government
      programme
     To understand whether resource allocation is adequate in the context of the
      programme objective
     To identify the major challenges to achieve “universalisation with quality”.
2.2 METHODOLOGY:
The scope and depth of the study required the use of various methods to collect data.
Government reports, papers by academicians and NGO reports were consulted initially
to understand the situation and then to compare the primary data collected from the
field for report writing. Primary data was collected using schedule, case studies,
personal interviews and Focus Group Discussions
 Case studies:
In order to follow the continuity of service delivery from the AWC and the impact on
growth, development and participation, 10 children (5 children below 3 years and 5
between 3-6 years) were selected from 10 different projects for case studies and
followed for a period of six months to assess the regularity of the services offered by the
AWCs.


Table 2: Coverage of Stakeholders through schedule
 Category of beneficiary       No. of stakeholders   No. of stakeholders   Total     no     of
                               per AWC               per Project           Questionnaires were
                                                                           filled up
  Mothers of children below    3                     30                    810
 three years of age
 Mothers of children between   3                     30                    810
 3 to 6 years
 Pregnant women                2                     20                    540
 Lactating mothers             2                     20                    540
 Adolescent girls              1                     10                    270
 Supervisors                                         1                     27
 AWW                           1                     10                    270
 ANMs                                                2                     54


                                              12
 Focus Group Discussions:
    o   FGDs were conducted in 11 projects (10 projects were selected from the 27
        projects covered through questionnaires and one project was identified from
        projects where AWCs have been newly sanctioned).
    o   Groups of 20 to 25 stakeholders (Beneficiaries, Community Leaders and
        Members, CDPOs, Supervisors, AWW, Helpers, MOs, ANMs, representatives
        from partner NGOs) participated in the discussion and shared their concern with
        the team of researchers.
 Personal Interviews:
One to one interview with one MLA was carried out to understand the community
leader’s perspective and participation (though interviews were planned with three MLAs
but only one gave an appointment.


2.3 COVERAGE
   Out of total 28 projects, the study was
    conducted in the 27 Projects2 (25 in
    Urban3 Area and two in Rural4 Area).
   After the pilot testing of the research
    design, the team decided to drop
    Madanpur Khadar as a project as it
    AWCs in that area had just opened and
    there was hardly any registration or
    service delivery.
   The team also decided to cover only 5
    AWCs in Najafgarh area as the distance between the AWCs were long and difficult
    to access.
   The study was designed in such a way to cover all the stake holders i.e.
    beneficiaries, all levels of functionaries, and community leaders as well as partner
    NGOs (Please refer to table-2).

2
 Location of these projects are mapped against the density of slum population in Annexure IV
3
 Urban:
Alipur, Anand, Parvat, Jama Masjid Jahangirpuri                 Narela Mehrauli            Mongolpuri,
Bagh Kare Khan, Geeta Khanpur Nabi                Wazirpur Karim, Okhla, Sultanpuri, Nizamuddin, Seemapuri,
Colony,       Govindpurti, Nand Nagri Tilak Vihar,              Shakkarpur, Trilokpuri, Shahdhara
Sangam Vihar                                                    Inderpuri,                 Shakurpur,
4
 Rural:
Najafgarh Kanjhawala

                                                    13
   The study took eleven months to complete from March 2006 to February 2007. The
    pilot testing began in March 2006 and collection of primary data, Focus Group
    Discussions and data entry continue till 2006. The analysis was completed by
    February 2007.


Problems faced while collecting data: Location of the AWCs was a real challenge as
the awareness among community about its existence was low. The ICDS functionaries
d cooperated with the investigators only after they were shown a letter of permission
from the director of ICDS.




                                         14
                                         Chapter 3
                                 Findings of the Study

“I was searching for the Anganwadi of Mangolpuri in the middle of August, 2006, but no one
could give any clue from the address I had in my hand.
After a long time I could identify a group of women sitting outside.
“Can you please tell me where the Anganwadi is?” I asked.
“What is that?”
“Anganwadi is where dal, chana etc, are distributed to children.”
“OK, two houses to the left”
“Don’t your children go to the Anganwadi?”
“No, but my sister- in- law’s sons go. There!” she pointed out to a lady washing clothes at one of
the municipality taps.
I approached her and said, “Does your child go to Anganwadi?”
“No, but I bring the khichdi or dalia for him,” she answered.
“How does it taste? Does your child enjoy it?”
“Not at all! Its so watery, the dalia swims in the water.”
I reached the anganwadi centre and could find only the landlady at around 11 am. It certainly did
not look like one. It was just a room with no children, no charts and no toys.
 Only two big empty drums were lying there…

                                 Sheetal, Field Investigator (Her experience during the study)




3.1 INFRASTRUCTURE
3.1.1 Location and Space
       There were no complaints regarding location and accessibility of the AWCs
        other     than   those     in
                                         Khanpur: A Centre with no space In Khanpur, the place used
        Govindpuri, Khyala and           as the premises of the AWC centre: is a 4 ft x 7 ft garage where
        Jahangirpuri areas where         the landlord keeps his motorcycle. There is no toilet, no
                                         drinking water facility. During summer and monsoon, it is
        AWCs were located on             difficult to have activities outside. Generally the activities are
                                         carried out in the open space which actually meant only for
        3rd or 4th floor making the      distribution of SNP, whose quality was questioned by everyone
        access      difficult    and     present in the meeting, including functionaries and
                                         beneficiaries.
        unsafe.
       58% AWWs complained of space constraint both for storage and for carrying out
        activities. In most centres, due to the inadequacy of space, the number of
        children registered is only 20-25 whereas, according to the norms, the number
        should be 40 for children between 3 to 6 years.
       10% of the AWCs have either kutcha infrastructure or they operate from jhopris.
        These centres have serious lack of space and cleanliness




                                                15
3.1.2 Rent
    As      per    our    survey,       96%
       centres     are    on     rent.   The
       allocation of rent is very low
       Rs.500. (the revised provision
       of rent since June 1, 2006)
       This is a matter of serious
       concern     according       to    90%
       Aanganwadi Workers and as
       communicated in 8 out of 10
       FGDs. All the functionaries
       have expressed the opinion
                                                 FGD outside an AWC that operates from a
       that “the rent should be raised
                                                 4’X7’ Scooter Garage
       to Rs.1000/- at least”.
    96% AWWs functioning from rented centres said that rent is irregular.
    As the rent is irregular, the landlords prefer not to give out premises exclusively for
       use of the Aanganwadi, so the centre cannot be locked. In these circumstances,
       the worker and supervisor do not feel it is safe to keep equipment inside. If the
       landlord has guests, or if someone in the house is not well, the centre cannot be
       opened.
    This poses a challenge for the regular functioning of the centre. There have also
        Comparison between Neenv Study, Delhi and FOCUS Report*          been   instances    of
        (Data on Active and Dormant States) Data on Infrastructure
                          Active         Delhi          Dormant          Supervisors        and
                          States         Neenv          States
                          (FOCUS )       Study          (FOCUS)
                                                                         Anganwadi     workers
        Own building      44%            0%             22%              being harassed by
        Kitchen           48%            -              29%
        Storage           57%            42%            55%              the landlord on the
        facilities                                                       ground of irregular
        Drinking          65%            57%            70%
        water                                                            payment of rent.
        Toilets           20%            58%            20%
           Note:* FOCUS Report
        The table shows that Delhi lags behind even the dormant States
        studied in the FOCUS Report as regards infrastructure


3.1.3 Drinking water and sanitation
       Only 57% of the centres have toilets, rests of the centre have common toilet
        (shared with landlords), 58% centers have access to clean drinking water
        sometimes the neighbours provide drinking water to the centre.
                                                   16
3.1.4 Scarcity of equipment
       82.23% of AWWs said there was scarcity of equipment like weighing machines,
        education kits, toys even jugs and buckets for water storage.


3.1.5 Recommendations
The study of ICDS in Delhi throw-up many issues of concern. Based on the fact finding,
discussion and interviews some recommendations are given below:
Infrastructure
       Norms should be specified for infrastructure. Tamil Nadu is already in the
        process of defining quality indicators for this component. There is already a
        checklist suggested by CIRCUS (Annexure III).
       For Delhi, it is suggested that there should be a minimum area prescribed for an
        AWC with demarcation of space for activities, storage and kitchen and with
        compulsory availability of independent toilet and drinking water.
       Pressure groups can be formed at the community level to monitor the availability
        of proper infrastructure and equipments in the centre.
       Allocation for rent in Delhi for AWCs should be enough to pay for adequate,
        exclusive space in urban areas. It is also vital that rent is paid regularly in order
        to save harassment of workers and supervisors.


3.2 OUTREACH
This section records the attendants in AWC on the day of the survey.
Table 3: Attendance
Beneficiary                            Average    no.   per   Registered as per   Attendance
                                       centre as per survey   AWW’s register      (avg no./ centre)
                                       done by AWWs           (avge no./centre)   as observed on
                                                                                  the day of survey
Children between 7 months to   Boys    35                     27                  9
3 years                        Girls   31                     25                  9
Children between 3-6 years     Boys    25                     16                  7
                               Girls   23                     15                  6
Pregnant ladies                        10                     9                   3
Lactating mothers                      11                     8                   3
Adolescent girls                       3                      Not even 1          Not even 1




                                               17
              The average has been          Children with Disability and ICDS
               arrived by dividing the       The survey team could not come across even one AWC
               total number of boys          with a child with disability. Only 2.89% AWWs had special

               and girls by the number       training on Disability. Inclusion of children with disabilities is

               of centres covered. As        national mandate. The system in ICDS does not stress
                                             importance of fulfilling this mandate.
               can be seen, there is a
               glaring contrast between the enrolment recorded in the registers of AWCs and
               the number of children actually found attending. It was also found that the
               surveys made by AWWs are irregular in Delhi. There are centres where no
               survey has occurred for more than three years in a row.


               Poverty groups like street children, rag pickers or children from the construction sites
               were not found attending AWCs during data collection. During an FGD in the
               Nizamuddin area it was noticed that rag pickers (they are considered to be Bangladeshis
               as they spoke Bengali and were Muslim in religion) living in that area are not given
               access to the centre though they lived in the same compound. Such vulnerable groups
                                                                                                          5
               were found to be excluded either intentionally or because of the poor quality of service


3.3 SUPPLEMENTARY NUTRITION PROGRAMME
3.3.1 Food Quality
Cooked food was started from July 2006. The comments from the beneficiaries and
AWWs are as follows:
           o     It was observed that in summer food became rotten as it was cooked early in
                 the morning.
           o     Dry ration was preferred to cooked food as it can be stored and also shared
                 within the family.
           o     Mothers expressed concerns over the caste of the cook.
           o     Complaints of poor quality came from 39% of the centres.
           o     Najafgarh area has specifically complained of insects and dirt found in the food
                 material




5
    The sub-section on exclusion is the record of the facts that emerged from focused group discussions
                                                      18
3.3.2 Quantity of SNP distribution
The children followed over six months in the case studies have been receiving food
from the AWC regularly. Some described the quantity as “one katori” some as “two
karchi”. Only one mother specifically mentioned 200 grams. On the days, when the
numbers of beneficiaries are more, less quantity of food is distributed.

   Observation and Finding on SNP: There is 100% coverage of SNP in Delhi, the
   concerns about regularity and quality is large.
   Status of SNP: Comparison between Neenv Study and the FOCUS States
                                   Active            Neenv Study   Dormant
                                   States            (Present      States
                                   (FOCUS )          study)        (FOCUS)
   % of AWCs where SNP             94                100           93
   is provided
   % of AWW who feel food          95                74            54
   distribution is regular
   % of AWW who feel food          2                 39            35
   is of poor quality




3.3.3 Regularity/irregularity in distributing SNP
26% of the centres who had complained about irregular food supply were mainly
surveyed before cooked food was initiated. However, during the days of polio
vaccination, irregularity was observed. One major problem faced was that there was no
   Complaints about quality of food are higher than those
fixed time of supply. There have been days when food has come after 1 pm.
   from the dormant states in the FOCUS Report.

3.3.4 Coverage of pregnant women and lactating mothers
On an average only 17 women under this category are to be registered in an AWC. On
an average 3 to 4 pregnant women and lactating mothers are found to be attending the
centre.


3.3.5 Sharing of SNP
Only 82 out of 2861 i.e 2.87%, beneficiaries interviewed are taking food in the centre,
76% beneficiaries are sharing SNP with their family members, and rest of them ie.
Around 21% are taking SNP to their home and consuming it themselves.




                                                          19
3.3.6 Recommendations
Supplementary Nutrition Programme
      Cooked food should be distributed at a fixed time, mutually convenient for
       AWWs and beneficiaries, every day in the quantity specified as per norms.
      Beneficiaries should be encouraged to eat food at the centre so that the nutrition
       targets are met and the problem of low birth weight babies and prevalence of
       anaemia among pregnant women can be brought down. This should be made
       mandatory.
      All children suffering from malnutrition should receive double nutrition. The
       children belonging to Grade III and Grade IV category, who are getting double
       nutrition, require medical intervention as well.
      Spending on nutrition and resource allocation for SNP in Delhi has emerged as
       an important concern. As per data provided on the website of WCD Ministry
       Delhi has spent Rs. 737 lakh in 2005-06 and Rs.694.29 lakh by 2006 May for
       SNP, which comes to 0.52 paise per day per beneficiary (all categories of
       beneficiaries included and assuming food is distributed 300 days a year). This is
       far below the Central Guideline of Rs.2/- per child. Delhi Government requires
       an amount of Rs.2326.84 lakhs a year to distribute SNP worth Rs 2 for same
       number (as per Delhi government’s estimate for number of children receiving
       SNP in the month of May 2006) of beneficiaries for 300 days a year.
      If the government aims to intervene in the current status of malnutrition and
       anaemia and ensure food security to young children, (15% of population),
       adequate resource allocation becomes a priority.
      Awareness of beneficiaries on nutrition needs of the children: The Focus
       Group Discussions revealed that a large number of beneficiaries were sharing
       SNP with other family members and were indifferent about the quantity of SNP
       served. This showed the lack of awareness on nutrition needs of children.


3.4 HEALTH AND NUTRITION MONITORING
3.4.1 Immunization
The following Table gives a comparison between secondary data from the Ministry’s
Website and Neenv Findings on Immunization Status in Delhi.




                                            20
   Table 4: Status of Immunization in Delhi
       Immunization   Secondary data from   % of children 0-3         % of children 3-6        % of Pregnant
                      WCD Ministry (%)      years (Neenv Study)       years (Neenv Study)      ladies
                                                                                               (Neenv Study)
       BCG            87                    98                        98
       Polio          79                    88                        88
       DPT I          71.7                  98                        98
       DPTII                                98                        98
       DPT III                              96                        97
       Measles        78                    86                        94
       MMR            -                     49                        68
       TT to PL       -                                                                        88
       Vitamin A      17.1                  25%


Table 4 indicates that coverage of immunization in Delhi is good. However the NFHS
data shows that the number of children fully immunized in Delhi has declined. 85% of
the immunizations are done by the ANMs in Primary Health Centres and Dispensaries.
This underlines the importance of the AWC-PHC linkage.


3.4.2 Weighing and Growth Monitoring
Table-5 below compares the information collected from AWWs and beneficiaries’ on
weighing. The data on weighing is not encouraging. It was found that most centres
shares the weighing machines as they either did not have it or the place to keep them.
    Table 5: Status of Weighing of the Beneficiaries as per Information provided by the
                              AWWs and the Beneficiaries
                   Item                    As per                As per          Active     Dormant
                                          AWW’s            beneficiary’s         Focus        Focus
                                           survey                survey          states       states
    % of 0-3 years children        81%               25%                   82%            47%
    weighed
    % of 3-6 year old children     68%               25%
    weighed
    %    of Pregnant   women       1.2%              0.9%
    weighed


The data thus reveals neglect of growth monitoring and interventions for malnutrition
and support to pregnant women.
The case studies on children that were followed give the following information:-
        Among the ten children followed for five to six months, 5 of them had not been
         weighed during these six months.
        The sixth child (who migrated to UP as a result of his father losing his job due to
         sealing drive in Delhi) also was not weighed.
        The reasons given were non-availability of weighing machine or the weighing
         machine not being in working condition.

                                                    21
      Out of these10 children, one nineteen-month old child suffered from calcium
       deficiency. He had received intervention at the PHC. Another 5-year old girl,
       who is weighed every three months, is only 14 kgs at the age of 5 years,
       whereas the average weight of an Indian girl at the age of 5 years should be
       17.7 kgs. The child is yet to receive any intervention on malnutrition.
      Another four-year old child who is weighed regularly is only 11 kg. She is in
       Grade II of malnutrition and is treated at the MCD Centre. She is also identified
       as an anaemic child and has been given blood at the MCD hospital.


3.4.3 Malnutrition
Identification of malnutrition, records on malnutrition and interventions were found to be
inadequate. Among all other centres surveyed, only 4 centres had data on grade III and
IV malnutrition. 17% of the centres had data on Grade I and 17% on Grade II
malnutrition. Only one centre has offered medical intervention and around 9% offered
double SNP to the malnourished children. 55% of the 27 projects covered could not
provide us any data on malnutrition. This raises doubts about the accuracy of the
number of malnourished children quoted by Delhi Government.
The Coverage of the issue of malnutrition in AWW’s training programmes was also
found inadequate. Out of the 242 AWWs interviewed, 27% had special training on AIDS
but only 18% on nutrition.


The monitoring and supervision mechanism of the scheme demands data on
malnutrition from both the AWW’s report as well as the CDPO’s report. However, that
the absence of data for so many projects goes unnoticed is a proof of negligence in the
monitoring mechanism of malnutrition for the children of the capital. The mothers who
participated in FGDs are largely unaware of the issue of malnutrition.




                                           22
       Discrepancy between data provided by AWWs and that by beneficiaries:
       o    87% AWCs had data on immunization for the children below 3 years and only
            67% for the 3-6 year old children.
       o    As per AWW data, 46% reported TT immunization of pregnant women where
            as the data collected from beneficiaries shows 88% pregnant women are
            immunized.
       o    88% of beneficiaries said that they have received iron tablets from PHCs. The
            AWWs records, however, have no data on iron tablet distribution which
            indicates that the AWWs records are not updated or there is a gap in linkage.
       o    Coverage of Vitamin A distribution: Data on Vitamin A distribution is available
            in 9% of the centres but the survey on beneficiaries reveals that 25% of the
            children below 6 have received Vitamin A.           This shows that though
            immunization is good, Vitamin A distribution has remained low.




3.4.4 Support of Senior Functionaries such as MO and ANM
84% of AWWs have said that the MO had not visited the centre for more than six
months. ANMs are more regular visitors. 51% of them visit centres once a month. But
as per the AWW’s experience only 28.5% have been supportive.


3.4.5 Recommendations
Monitoring of Health Status (Growth Chart)
          Growth charts for all children should be maintained and weight taken on a
           monthly basis for children below two years and on a three monthly basis for the
           rest as per norms. Monitoring and supervision on this record keeping needs to
           be tightened up.
          There is need to build the capacity of both AWWs and the beneficiaries,
           especially the parents of children below six, on this issue
          Proper records of children suffering from malnutrition and the records of the
           impact of intervention should be kept.
          The record on all immunization of all children in the survey area should be
           recorded in the AWWs’ records
          There is no attention to disability. AWWs survey to include disability and
           registration of children with disability should be specified in the guidelines of the
           Scheme. Training programmes of AWWs must have comprehensive inputs on
           disability.

                                                 23
       The monitoring system leaves much to be desired. Its proper implementation
        requires urgent attention.
       Quality control of Nutrition Health Education component of the Scheme can be
        brought about by consciously involving the Mahila Mandals. AWWs to keep a
        track on whether mothers are regularly attending NHEs and take necessary
        steps to ensure participation.


3.5 PRE-SCHOOL EDUCATION
       Pre-school activities lack focus and priority and are few and irregular. There is
        inadequate space for pre-school activities and inadequate teaching aids. 0-3
        age group is left out and mothers of children below three years do not receive
        any input on learning needs of this age group.
       In 44% centres on the day of the survey (the entire survey lasted 8 months) no
        children were found attending pre-school. The 45.62% AWCs had an average of
        14 children and    in the remaining 11% centers no children were found despite
        three visits to the Anganwadi.
       An average of 14 children was observed attending the centres for pre school
        education. The attendance register in more than 70% cases show attendance
        varying from 5 to 20 children on the previous day but 43.38% centres recorded
        no attendance on the day of the survey.


57.83% Anganwadis reported space constraint for activities. Most of the AWCs did not
have the place to seat 40 children. Focus group discussions brought out that on some
days classes are carried out in open spaces as there is no space the centre.


Table 6: Attendance in Pre-School
               Registered  as   Average no of    Attending as per the      Average    no    of
               per      AWW’s   children         attendance recorded by    children attending
               record           registered per   the surveyor on the day   per centre
                                centre           of the survey
Boys           4234             16               1746                      7
Girls          3930             15               1618                      6
Total          8164             31               3364                      13



None of the Anganwadis provide any ECCE inputs to children below 3 years of age.
The mothers are also not given any inputs on stimulating exercises for children below
three years of age.

                                            24
3.5.1 Recommendations
Pre-School Education
     AWCs should have enough space for pre-school education so that at least 40 to
      50 children can be registered and every day learning activities can be carried
      out for 3-4 hours a day
     The AWWs require focused training on pre-school with detailed inputs on
      playway methods and skills to use teaching aids. The current time allotted to the
      pre school component in AWW’s training is only 7days in three months.
     All centres need to be provided with quality teaching aids. The AWW can also
      make teaching aids from waste materials to make learning joyful. Swaran Park,
      Kanjhawla’s example can be shared with other AWWs. The Local MLA’s Fund
      can be utilized to equip the centre with teaching aids. Elders of the community
      can be encouraged to participate in story telling sessions and opportunities
      created to involve them in making teaching aids from waste materials.
     Each AWC needs to have two AWWs. One trained worker needs to focus on
      pre-school age group, while the second worker needs to focus on 0-3 age group
      to address their learning needs as well as other issues like SNP, growth
      monitoring, counseling etc. The two worker model will help in coverage of the
      entire age group 0-3 and 3-6 years.
     Early Childhood Care and Development (0-6 years) must be brought under the
      Fundamental Right to Education. That will firmly place health, education and
      nutrition under state responsibility and ensure attention to budgets and adequate
      human resource.




                                         25
During the ICDS study, I visited four projects (Govindpuri, Nazafgarh, Jahangirpuri and Tilak
Nagar). I faced several problems in these projects and also understood the functioning of
these projects. All the four projects did not at all reveal the motive of the government with
which it had been started and this left me with a negative impression about these projects. I
visited the Nazafgarh Project, which is a rural project, I could not see any children, though
after sometime the helper managed to call a few of them. As this project is located at the
fringes of Delhi I reached the Anganwadi centre around noon, and found the centre closed.
Here one person told me that this centre usually opened at this hour. He also gave the
address of the worker which was just behind the centre. I went and knocked at the door but to
my dismay no one opened the door and so I proceeded to the next Anganwadi centre which
also was in the same condition. Here the workers were not in the centre and were found
chatting in a nearby area. When I spoke to them, they told me that the supervisor does not
visit the centre for months and the CDPO never visits.
It is clear from this that the administrators themselves do not take any initiative and so the
community also does not show interest.
                                                            Surveyor’s Observation




        FGD in an AWC Compound under Nizamuddin Project

                                           26
                                          Chapter 4
        Role of Functionaries and Issues Pertaining to their Role

4.1 THE ANGANWADI WORKER
The Anganwadi is the place through
which services reach the beneficiary
families of the community and the
AWW is primarily responsible for
service delivery. She is the link
between the community and ICDS,
the health functionaries and ICDS
and also between primary education
and pre school education. The AWW
has perhaps the most important role
in service delivery of this largest
government programme for children
below six years.                          MO, Supervisors, AWW at an FGD

4.1.1 Background and Training
Of the 242 workers interviewed, 33% are in the age group of 30-40 years and, 46% in
the age group of 40-50 years. 32% of the 242 AWWs are Xth pass, 40% XIIth pass and
28% are graduates. 93% have received job training and 82% have received the week-
long refresher course. Apart from that, 10% are trained on RCH, 27% on AIDS and 18%
on nutrition.


4.1.2 Ad hoc Status – Late payment of honorarium
        AWWs do not enjoy an employee status and there is no security of job. They are
         hired on an ad hoc basis and receive a fixed honorarium of Rs. 1500 per month
         (Rs 1000fromCentral Goverenment and Rs 200-500 from the state). One of the
         AWWs met during FGDs said, “The scheme is “sarkari” (government), all
         functionaries except us are “sarkari”. We are the only ones in this scheme which
         is “gair-sarkari” (private)”
        The honorarium is not paid regularly. 96% of the AWWs interviewed said they
         do not receive payment on time. This is a serious issue and affects the morale.



                                            27
       The worker does not feel motivated to come to the centre everyday since the
       government is not serious about paying their honorarium every month.
      At times AWWs even have to purchase registers, earthen pots and water
       containers with their own money. Sometimes the AWWs have paid the rent in
       order to get rid of the landlord’s harassment.




4.1.3 Level of support the AWWs have received from other functionaries and
community
      14% have expressed that they have received support from CDPOs
      40% from beneficiary families
      12% have received support from Mahila Mandals
      6% from local MLAs.
      All the AWWs have said that they have received support from the Supervisors
       and ANMs.


4.1.4 Extra Responsibilities
Giving polio drops (a small payment is given for this task), carrying out surveys for
widows’ pension, poverty surveys and all information related to schemes concerning
women and children are some of the extra tasks they are required to perform. As the
priority has always been on these surveys, the activities of AWCs apart from SNP
distributions take a back seat during these days.


4.1.5 Irregularity in attendance of AWWs
Majority of the AWWs are very irregular as they are demoralized due to low wages,
untimely payments and family pressure resulting from this. The following diagram
explains the vicious circle that is generated out of this neglect and de-motivation.
                                    Fig: 1




                                             28
                           Ad hoc status and meager, irregular payment, problems of
                          day to day functioning go unattended and non-supervised.
                          AWWs feel neglected and de-motivated




                                                       De-motivated         and       under
     Senior Functionaries feel AWCs are                supervised, AWW is irregular in
     not wanted by people, hence neglect               attendance and not committed to
     supervision and trouble shooting                  quality in delivering services




                        A non sensitized Community receiving
                        low quality service is uninterested in the
                        functioning of AWC. There is no
                        demand generated from the ground and
                        children miss out on their entitlements



4.2 THE HELPER
The helpers are playing a very major role in AWCs. In most of the days the study team
found only the helper at the AWC distributing food. As per their role definition, they are
supposed to cook the food. However, as NGOs are mainly distributing cooked food in
Delhi, their role has become distribution of food. They also make home visits.


4.3 CDPOs AND SUPERVISORS
4.3.1 Monitoring and Supervision by CDPOs and Supervisors
The mechanism of monitoring and supervision and the forms devised for monthly
reporting of CDPOs Supervisors and AWWs as per the Scheme is comprehensive
enough. Yet large gaps were observed in the status of monitoring.
The Supervisor is the functionary who is supposed to provide support to the AWW on a
regular basis. From the Focus Group Discussions, it was found that there are many
CDPOs who are willing to provide the required support to the supervisors and AWWs
but cannot do so as they have too many centres to manage. The norm is 100 centres
per CDPO but, in more than 80% cases, the average number of centres supervised by
the CDPO was more than 120. They are not able to do justice to their responsibilities.
Some CDPOs were supervising more than one Project. There are Supervisors who
monitor more than 50-80 centres (20-25 is the number specified by the ICDS norm).
Hence the centres remain unvisited and records unchecked. Supervisors are given
election duties and other office duties for a long period of time. Hence they are forced to
ignore their roles as ICDS Supervisors and give their ad hoc roles a priority. The
                                                  29
Anganwadi Worker hence remains largely unsupervised as a result the field workers
were unable to meet AWWs in 28 centres in spite of making three visits.


4.3.2 Lacunae in the chain of supervision: The chain supervision, between CDPO,
Supervisor and Anganwadi Workers is not functioning properly.
    66% of AWWs said the CDPOs have not visited the centre for more than 6 months
    14% AWWs have said that they have received support from the CDPO.


4.3.3 Lacunae in monitoring record keeping: Malnutrition data was missing in all 10
centres surveyed in 15 out of 27 projects. This shows that record keeping has gone
unsupervised. With a 63% prevalence of anaemia among Delhi’s children, this
negligence cannot be justified in any way.




4.4 RECOMMENDATIONS
      In order to strengthen the service delivery system of ICDS, there is a need to
       strengthen the chain of support; the worker receives from ANM, Supervisors and
       CDPOs. There should be regular monitoring and supervision of health records.
       This will have an impact on the performance. The AWWs need to receive
       regular feedback from the CDPOs and Supervisors on their work and their
       problems need to be listened to.
           o   There should be monthly visits by CDPOs to share their feedback on the
               monthly report with the AWWs. They should also interact with the
               community to address their concerns.
           o   Records need to be checked more frequently by CDPOs and Supervisor.
               Reports without proper information should be looked into and disciplinary
               actions should be taken. The whole system needs to be tightened up.
           o   Number of centres monitored by Supervisors and CDPOs should be as
               per the norms of the Scheme in order to make supervision more effective
      Providing the AWW an employee status is very important and payment
       should be regular. It will contribute towards self-esteem and motivation and
       assist in improving the quality of the service.
      The community starting from the local leaders to the local residents needs to
       play a supportive role. In order to do so, a systematic and well thought out


                                             30
       awareness programming is necessary which has institutionalized norms of
       participation and specific budget.
      The system of using the AWW for duties unrelated to ICDS needs to be stopped
       immediately.


The researchers observed a tone of hopelessness about the system in the
functionaries.   Some even felt Delhi does not need AWCs as there is hardly any
poverty. To end this chapter in a positive note we quote, one CDPO who felt that our
initiative to study the ICDS with the objective of improving it was important as the
Scheme is very good but is not reaching the people in its full capacity. She said,” Hum
log ummid kar sakte hain aur aplog kaushish kar sakte hain”




                                            31
                                      Chapter 5
                Role of the Community and their Participation

5.1 COMMUNITY PARTICIPATION AND AWARENESS
     Community participation is confined to the parents of the child beneficiaries who
       help in the distribution of food and drinking water for the centre.
      The rest of the community has remained mainly non-participatory. The
       community mostly views the AWCs as food-distributing centres.
      The mothers do not participate regularly in the Mahila Mandal meetings and are
       also not aware about malnutrition, anaemia, growth monitoring and the role of
       nutrition in improving health conditions even though the Nutrition and Health
       Education (NHE) meetings have sensitized the community on these aspects.
      Lack of knowledge on a Scheme which has been in existence for 33 years can
       only be explained by lack of interest on the part of both the community and the
       functionaries.




         AWW with the children in the Swarn Park AWC under Kanjhawala Project




                                            32
5.1.1 Involvement of community members
     The 242 AWWs interviewed said that 40% centres have received support from
        the beneficiary families.
                                            Role of Community in making the Anganwadi
       Only 6% centres said the            function in Khanjhawala Block.
        local MLA has visited the           The community in Khanjhawala has shown great
                                            initiative and come forward on their own to help the
        centre    and     10%      have     Anganwadi worker. This was the first AWC that the
                                            Study Team found running well. Despite the problems
        received support from the           of low budget, irregular supplies etc., the community
        local Pradhan. It was found         were able to assist the Anganwadi worker to run a
                                            lively Anganwadi with good activities, clean
        from     the   Focus      Group     environment, personal hygiene of children, up-to-date
                                            records, mother’s meetings and functional pre-school
        Discussion that absence of          etc. The surveyor also found all the material required
        interest of local leaders and       for pre-school education.
                                            The above reveals the potential ICDS has of fulfilling
        weaker         sections     are     Child Rights when local communities come forward and
                                            take an interest.
        together are responsible for
        low demand and participation from the community. The MLA interviewed felt that
        his area (Karol Bagh) did not require anganwadi centres. He felt that AWCs are
        more relevant for villages. He felt Delhi requires a proper survey and relocation
        of centres according to need. He had not spent any amount of his development
        fund on AWCs. It is apparent that the young child was no priority on the political
        agenda and therefore, the Scheme has been neglected.


Advantages and disadvantages of NGO-run AWC in a New Resettlement Colony:
The Bawana AWC was handed over by the government to NGOs. This provided the team an
opportunity to look at the advantages and disadvantages of NGO-run ICDS centres which was
introduced by the state in 2006. However, the findings revealed that NGO’s involvement may not
actually result in quality improvement. It was found that there are no health services provided by
the NGO center and no linkage was established with health departments. The beneficiaries
access nearby hospitals independently for health check ups and immunization. The centers also
did not have teaching aids and were very unclean. Moreover, the only group of beneficiaries was
the twenty children in the age group of 3 to 6 years. It is therefore evident that that the system of
NGO-run AWCs have problems that need to be addressed. Additionally, the community does not
appear to express its dissatisfaction with the centre as NGOs are considered a private domain.
Not much had been done to sensitize the community on the programme. The NGOs role as
implementers of the programme has actually eliminated the role of the community as a partner
and advocate.




                                                 33
5.2 RECOMMENDATIONS
     Awareness, sensitization and community participation is a major task which
      needs to be addressed. Mahila Mandals, AWWs and ANMs need to work on
      developing active participation of mothers, pregnant women and adolescent girls
      so that they are all sensitized on the importance of nutrition and on the issues of
      malnutrition and anaemia.
     There is a need to build the capacity of the community leaders on the issue of
      importance of Early Childhood and the ICDS programme. Only then will
      community leaders take up the quality issues of AWCs as part of their political
      agenda and become a part of community monitoring. Advocacy efforts with the
      community leaders should be initiated to encourages use of MLA funds to equip
      AWCs in their area.
     The objectives and services of ICDS need to be communicated and discussions
      held with the community so that they can demand good implementation. This will
      require putting in place a good awareness programme.
     Information on ICDS needs to be communicated by government on a scale
      similar to that adopted for the polio programme.
     The State needs to review its policy on handing over AWC to NGOs. NGO role
      as community mobilisers, trainers etc will be of benefit. State systems need to
      be responsible for implementation of services and accountability to the people.
     A quality control group comprising CDPO, Supervisor, AWW, community
      leaders, representatives from families of beneficiaries, representatives from local
      youth groups, Mahila Mandal Members,and representatives from local NGOs
      can be formed to discuss quality issues and sort out problems at local levels.
      CDPOs or community leaders can take up issues that demand attention of
      higher authorities and the team can regularly follow up till action is taken.




                                           34
                                               Chapter 6
                                              Conclusion

The Study raises many implementation issues which require urgent attention,
particularly in the context of both NFHS III data and the context of Supreme Court
Orders to Universalise ICDS and reach all the six components of the programme to
children under six.
Concern about the rights of under six’s are widespread and debated across the country
within the right to food campaign of which Neenv is a partner. An expert group6 draws
up a framework for action for the 11th Plan under which some key recommendations
have been outlined. They are as follows:


Universalisation with Quality:
“Universalisation with quality” should be the overarching goal for ICDS in the 11th Plan.
This would include raising the number of Anganwadis to a minimum of 14 lakhs (with
priority to disadvantaged groups), extending all ICDS services to all children under six
and all eligible women, and improving the quality of services.


Focus on Children Under Three:
ICDS should give much greater priority to children under the age of three years. This
would include providing adequate incentives to ASHAs for the relevant services
(including home-based neonatal care, breastfeeding and nutrition support), provision of
nutritious take-home rations (THR), better training on issues related to children under
three, and the adoption of “two-worker” model.


Two-worker Model:
Adequate care of children under three combined with effective pre-school education for
children aged 3-6 years cannot be achieved without the involvement of two Anganwadi
workers (along with the Anganwadi helper).


Anganwadi-cum-
Crèches ensure that adequate care and development opportunities are available to
children, whose mothers go for work outside the home (especially if there are no adult


6
    Strategies for Children under Six: A Framework for 11 th Plan, June 2007.
                                                      35
carers at home). Crèches are required for children, in both the 0-3 and the 3-6 age
groups, for the entire day. The Anganwadi centres can provide this service in the
village. To begin with it is recommended that 10% of all Anganwadis be converted into
Anganwadi-cum-creches. This would mean that these centres are open full time, both
the workers are present all day and are given additional training on running a crèche.


Pre-school education:
For children aged 3-6 years, pre-school education should be the primary focus of ICDS
activities. Aside from adoption of two worker model, this requires appropriate training,
infrastructure, equipment, supervision and support.


Nutrition Programmes:
For children in the age group of 3-6 years, the Supplementary Nutrition Programme
(SNP) should be based on hot, cooked, nutritious meals, along the same lines (and with
the same financial norms) as the “mid-day meal” scheme in primary schools. For
younger children, it should be based on carefully-designed “take-home rations” (THR),
combined with nutrition counseling.


The Supreme Court, in its landmark judgment in December 2006,( PIL…) has given the
deadline of December 2008 to achieve universalisation of ICDS, which in absolute term
implies having 14 lakh operational Anganwadi Centres across the country by December
2008. The country needs to plan the operationalising of more than 6 lakh centres across
the country within a span of 24 months in accordance with this Supreme Court order.
Key orders of the Supreme Court are as follows:


      Government of India shall have to sanction and operationalise a minimum of 14
       lakh AWCs in a phased manner by December 2008.
      The universalisation involves extending all ICDS services to every child under
       the age of six, all pregnant women and lactating mother and all adolescent girls.
      All the State Governments and Union Territories shall fully implement the ICDS
       by allocating Rs. 2/- per child per day, Rs. 2.70 per severely malnourished child
       and Rs. 2.30 for every pregnant woman, nursing mother and adolescent girl on
       SNP.




                                           36
        Chief Secretaries of all State Governments/UTs are directed to submit affidavits
         of all habitations with a majority of SC/ST households and provide plan of action
         for ensuring that all these habitations have functioning AWCs within two years.
        Contractors shall not be used for supply of nutrition in AWCs and preferably
         ICDS funds are spent by making use of village communities, self-help groups
         and Mahila Mandals for buying grains and preparation of meals.
        While maintaining the upper limit of one AWC per 1000 population, the minimum
         limit for opening a new AWC is a population of 300 may be kept in view.


Keeping the findings of the Neenv Study in mind and the many implementation and
quality issues it raises, the state machinery will have to gear up to comply not only with
Supreme Court Orders but also to address the status of children in Delhi. Unfortunately,
the budget of 2007-08 is only 50% of the estimation7 given by the National Advisory
Committee in 2004. The vast gap of quality and coverage is to be filled up and will
require attention to infrastructure, monitoring, community participation training,
workforce morale and other closely related issues. It is hoped that the findings of the
Study will be useful in addressing the above.




7
 The National Advisory Committee (NAC) headed by Ms. Sonia Gandhi assessed a requirement of Rs. 9600 crore for
universalisation in the year 2004
                                                     37
                           BIBLIOGRAPHY/ REFERENCES




Delhi Human Development Report 2006
Economic Survey of Delhi 2005- 2006
FOCUS on Children under Six
National Plan of Action for Children 2005
Report of Working Group on Development on Children for the Eleventh Five Year Plan
Strategies for Children under Six, A Framework for the 11th Plan
Status of the World’s Children 2006
Strong Foundations - Early Childhood Care and Education EFA Global Monitoring
Report – 2006


Websites:
Website of Ministry of Women and Child Development -
Website of Delhi Government
Website of NFHS India




                                            38
Annexure I
                               ICDS in India and Delhi
                                  India                              Delhi
Operational Projects in 2005      5635                               29
Funds released in 2005            Rs. 1995564.80 L                   Rs. 1222.57 Lakhs (.87p per child
                                                                     per day)
No. of Child beneficiaries 0-3 18165501 L                            238423
years
No. of child beneficiaries         22589909                          149384
3-6 years
AWC Sanctioned                     956060                            4428
AWC Operational                    748229                            3852
SNP Beneficiaries
                Children 0-6       46717707                          387807
                Women               9500401                           76933
                Total              56218108                          464740
Preschool Beneficiaries            24492450 (avg of 34 per AWC)      151554 ( Avg of 39-40 per AWC)
Source: Website of Ministry of Women and Child Development



Annexure II
Some of the Millennium Development Goals and National Plan of Action
Commitments related to health (NPA – Chapter on Child Survival)
     Reducing IMR – To reduce IMR to below 30 per 1000 live births by 2010
     Reducing CMR – To reduce CMR to 31 per 1000 live births by 2010
     Reducing MMR – To reduce Maternal Mortality Rate to below 100 per 100000 live births
        by 2010.
     To reduce Neonatal Mortality Rate to below 18 per 1000 live births by 2010
     Reducing Malnutrition among children – To eliminate malnutrition as a national priority
     To reduce under five malnutrition and low birth weight by half by 2010
     To ensure adequate neo-natal and infant nutrition
     To reduce moderate and severe malnutrition among preschool children by half
     To reduce chronic under nutrition and stunted growth in children
     Improving water and sanitation coverage both in rural and in urban areas
     Addressing Anemia and Vitamin A deficiency


How much we spend nationally
Year                              % share of
                                  Child Health in Central Child
                                  Budget
2004                              0.423
2005                              0.527
2006-07                           0.556
Source: GOI Expenditure Budget 2004-05, 2005-06, 2006-07 (Vols 1&2) and HAQ: Centre for Child Rights,
Delhi




                                                 39
Location of the 27 ICDS Projects in Delhi (blue dots are showing location of
projects) where the Study was conducted against the density of slum population
(Source: Census, 2001)




                                      40

				
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