INTEGRATED CHILD DEVELOPMENT SERVICES AN ASSESSMENT
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- Title
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AN ASSESSMENT - extracted text
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INTEGRATED CHILD DEVELOPMENT SERVICES
AN ASSESSMENT
E
PREPARED FOR UNICEF
BY
Dr. K.G. Krishnamurthy
Dr. M.V. Nadkarni
MAY 1983
COMPONENTS OF THE INTEGRATED CHILD
DEVELOPMENT SERVICES SCHEME
© SUPPLEMENTARY NUTRITION
O IMMUNIZATION
O HEALTH CHECK-UP
® REFERRAL SERVICES ’
® NUTRITION AND HEALTH EDUCATION
O NON FORMAL PRE-SCHOOL EDUCATION
Published by
UNICEF
REGIONAL OFFICE FOR SOUTH CENTRAL ASIA
This publication reflects the views of the
authors and not necessarily those of UNICEF
HEALTH
. •.
Vein, i Block
Ko if;1, r-i'<j' I a
Bangalore-560034 •
{ndi a
•
“''MMUNITY-H’’-
INTEGRATED CHUD DEVELOPMENT SERVICES
AN ASSESSMENT
Prepared for UNICEF
By
Dr. K.G. Krishnamurthy
Dr. M.V. Nadkami
May 1983
ICDS
AN ASSESSMENT
TABLE OF CONTENTS
Page
I
-
Introduction
1
II
—
The Situation of Children in India
4
III
-
Past Experience and the Present Scheme
11/
IV
-
Assessment of ICDS
26 /
V
-
An Analysis of Benefits and Resource
Involvement
36
Suirmary and Conclusions
48 .
References
79
VII
-
1
CHAPTER - I
INTRODUCTION
It is new widely conceded that the benefits of economic
growth do not automatically reach the poor, and their children.
Even adult-oriented anti-poverty programmes do not necessarily
benefit children, or inprove the environment in which they have to
live and grow.
The poverty-induced neglect of children ought to
disappear if poverty itself disappears.
appears too distant at present.
of
Such a prospect, however,
Children of the poor are victims
the process which excludes those with little or no access
to productive resources from the benefits of economic growth.
These
benefits are usually oriented to increasing production rather than
inproving the quality of life.
The need for the state's intervention to correct such a
distortion becomes, therefore, evident.
It has to provide health,
sanitation, education and an infrastructure whereby every child
finds opportunities and encouragement to develop in a healthy and
stimulating environment.
Such a programme is most effective when
it is part of an effort at community development complementing other
measures to banish poverty and hunger.
It cannot be operated in the
spirit of charity, doles, or with bureaucratic overbearing.
A child
development programme operated in the right spirit can be a catalytic
agent for change and serve as an entry point to improve the environ
ment and quality of life of the poor.
'
The Integrated Child Development Services (ICDS) Scheme must
be viewed and appraised in this broad perspective.
experimental basis in 1975, comprising
Started on an
only 33 projects - 17 rural,
12 tribal and 4 urban, it has now received government priority and is
2
included , as itan 15, in the Prime Minister's revised 20-Point
Programme for Social Development.
projects have been sanctioned.
By the end of 1982-83, 620 ICDS
This number will rise to 1000 by
the end of the current Five Year Plan which ends in March 1985.
When
these became fully operational, the Scheme will provide immunization
and health check-up services to 14 million children and 2 million
women, supplementary nutrition to 8 million children and women, and
non-formal education to 6 million children.
This study is an attempt to take stock of the programme,
to assess its implications for children and its impact on the
quality of their lives.
The lessons learnt from such an exercise
would be useful in improving the implementation of the programme,
where it is already operational, and in designing new projects
more effectively.
We have, therefore, taken an overall perspective
of ICDS including the nutritional, medical, social and economic
aspects.
Several evaluations and studies have been conducted by the
Planning Commission and by academic institutions but these have
concentrated on one or more aspects of the Scheme.
Moreover, the
data for the latest report of the Programme Evaluation Organisation
(PEO) of the Planning Commission was collected four years ago.
Mequate feed-back based on recent information is not available.
For this study, a sample survey was conducted in eight states and
one Union Territory (Delhi) where the Scheme has been in operation
for four years or more.
It also incorporates the findings of
previous evaluations and studies.
The second chapter of this study reviews the present situation
of children in India and identifies some of the major problems which
ICDS is designed to combat.
Chapter three briefly reviews past GOI
efforts to promote child welfare and outlines the background experience
from which ICDS has evolved.
This leads us to a discussion of the
objectives, and organisational structure of ICDS.
Chapter four
3
discusses the objectives, the methodology and frame adopted for
the survey.
Chapter five attempts to assess the social and economic
benefits expected from the Scheme and shows how, when it is effectively
inplenented, the benefits would be far more significant than the
extra resources involved.
While an indication of
costs involved is
given, it is argued here that a quantitative appraisal in terms of
a social cost-benefit analysis is not possible and, if attempted,
it could be misleading.
However, steps to make the Scheme more
cost-effective are indicated.
The sixth and final chapter, summarizes the conclusions and
suggests areas for future action.
4
CHAPTER II
THE SITOATION OF CHILDREN IN INDIA
' The majority of children in India are underprivileged.
They
live under social, economic and environmental conditions which
hamper growth and development.
Many families live at the subsistence
level and are plagued with illiteracy and unemployment.
Socio
religious factors, traditional values, differential sex upbringing
and the health and nutritional status of the mothers hamper the
birth and growth of healthy infants.
The problems relating to
child care and development are therefore complex.
made
An attempt is
here to highlight seme of the more prevalent problems facing
the Indian child.
MORTALITY AND MORBIDITY
The two major child health problems in India are the high
incidence of infant mortality and morbidity.
Though the infant
mortality rate (IMR) has cone down frem 204 per thousand live births
in 1915 to 160 in 1947 and 125 in 1978, the rates continue to be very
high compared to those prevalent in other developing countries.
The
IMR is not only higher in rural areas (136 in 1978 as compared to
70 in urban areas) but remains relatively stable while it has
continued to drop in urban areas.
Scheduled castes have a higher
level of IMR in both the rural and urban setting (159 in rural areas
and 90 in urban areas in 1978).
Female illiteracy and age at
marriage have been associated'with IMR.
In the state of Kerala, the
fall in the IMR and the birth rate has been attributed to the
higher level of female literacy and age at marriage.
Several studips
have established a relationship between the level of IMR and the
availability of basic amenities like safe drinking water, proper
nutrition, medical facilities, and access to communication1.
1.
UNICEF-1981: An analysis of the situation of children in India
(Draft Report - UNICEF - New Delhi).
5
Estimates of infant mortality in rural and urban areas in
different states in India are given in the following table.
Table I:
Estimates of Infant Mortality in Rural and
Urban Areas in Different States (5) in 1971
State/Union Terriroty
Infant deaths (per live
1000 births)
Rural
Urban
Andhra Pradesh
112.6
63.7
Gujarat
145.1
108.7
Haryana
64.0
52.0
Jammu & Kashmir
74.1
49.4
Kerala
58.1
45.0
Madhya Pradesh
141.3
75.6
Maharashtra
107.1
82.2
Orissa
132.9
79.1
Punjab
108.0
71.7
Rajasthan
112.8
74.2
Tamil Nadu
127.0
91.0
Uttar Pradesh
100.5
121.4
West Bengal
173.4
68.9
2.
Office of the Registrar General, Ministry of Heme Affairs, GOI Survey of Infant and Child Mortality - a Preliminary Report New Delhi, 1979.
6
Studies indicate that approximately 40 per cent of the
deaths are among children below 5 years of age.
Of these, about
half arp in the age group 0-12 months, with a high rate of mortality
in the first few days of life, i.e., less than 7 days.
The main
causes being diarrhoeal, gastro-intestinal and respiratory diseases.
In the age group 1-4 years, mortality has been associated with
respiratory, digestive and parasitic diseases.
Excessive neonatal
3
mortality is also caused by pre-natal conditions .
Low birth
weight, maternal infections, complications arising out of pregnancy
and delivery are closely linked with high mortality rates.
INFANT MORTALITY AND AGE OF THE MOTHER
It has been established that maternal age and birth order
have a direct bearing on the health and survival of the infant.
4
An inter-American Investigation of Mortality revealed that infant
death rates are highest for mothers under 20 years of age, and
lowest for mothers in the 25-29 years age group. Data frcrn Indian
5
studies support these findings . The average age of females at
marriage is still very low.
Even though it went up to 18 in urban
areas, it is still below 16 in many states.
This is followed
by immediate and frequent pregnancies with inadequate spacing
3.
Shah M. and P.M. Udami, "Analysis of Vital Statistics
from the Rural Community of Palghar" Indian Paediatrics,
Vol. 6, No.11, October 1969,
4.
Puffer R. R. and C.V. Gerrano - Patterns of Mortal ity
and Childhood, Washington - Pan American Health
Organisation 1973 (PAHO Scientific Publication NO.262)
5.
The OPCAT Palghar Study established high death rates
among babies of young mothers under 20 years of age.
7
Social custom and the perceived role of women in the family and
society are the main obstacles to change.
INFANT MORTALITY AND BIRIH WEIGHT
According to a study conducted by Dr. B.N. Tandon and
his colleagues
in 1981 only 23 per cent of rural and 27.4 per cent
of tribal children have normal weights for their age.
They estimated
that 17.4 per cent of rural and 19.4 per cent of tribal children
suffer from severe malnutrition (Grade III and Grade IV) .
Official
Government estimates indicate that 30 per cent of the children bom
7
in India weigh less than 2500 grams at birth .
PROTEIN AND ENERGY REQUIREMENTS
It han been estimated that the diet of an Indian pre-school
child, subsisting on cereals and pulses, could provide adequate
g
protein and energy requirements if consumed in large enough quantities .
However, the quantity consumed is generally too inadequate to fulfil
the energy needs,
with the result that the child suffers from
6.
Tandon B.N. - Ramachander K. and Bhatnagar S. 1981 Integrated Child Development Services in India Objectives, Organization and Baseline Survey of the
Project Population - Indian Journal of Medical Research March, pp. 374-384.
7.
Ministry of Health & Family Welfare, Government of India.
Health for All by 2000 AD; Report of the Working Group,
25 March 1981.
8.
Gopalan, C. and Narasinga Rao, B.S. (1971)/
Proc. Nutr. Soc.India, India 10, 111.
8
calorie deficiency as well as incidental protein deficiency.
The
average Indian child, 1-5 years old, consumes 810 calories per day
against the ICMR recanmended allowance of 1200 calories .
Among
adults, a large proportion receive 80 per cent of their required food
input1^.
The average pregnant or nursing mother consumes 1400-1500
calories as against the 2500-2900 calories per day recommended
by the ICMR.11
PREVALENCE OF DEFICIENCY DISEASES
In 1978, the National Nutrition Monitoring Bureau examined
12
a total of 5823 infants and pie-school children in eleven states
(see Table II).
The most commonly observed deficiencies are
Protein Energy Malnutrition (PEM) and Vitamin A and B group
deficiencies.
PEM is more frequent in children under five years of
age while vitamin deficiencies prevail among those above the
age of five.
Clinical cases of marasmus/emaciation and kwashiorkor were
identified in all the states though marasmus/emaciation is more
prevalent than kwashiorkor.
Similarly, ocular signs of ViFarmn a
deficiency like Xerosis, Bitot spots, and oral lesions of
B Cctrplex deficiency signs like stomatitis, angular stomatitis,
and glossitis were identified in all states.
The highest prevalence9
10
11
12
9.
Srikantia S.G. (1973)/Proc. Nutr. Soc. of India 12
10.
Narasinga Rao B.S. Visweswara Rao, K. and Nadamnni
Naidu (1969), Ind. J. Nutr. Dietet. 6 238.
11.
"Reccmnended Dietary Allowances for Indians" 1981
ICMR, New Delhi.
12.
National Nutrition Monitoring Bureau, Report for
the year 1978 (1979).
Table II
9
Percentage prevalence of deficiency signs
Deficiency signs
Ker
ala
Tamilnadu
Kar
na
taka
Andhra
Pradesh
Maha
rash
tra
Guja
rat
No. of cases
observed :
337
647
948
454
795
803
1.Oedema
a) Infants
b) Pre-School
children
2.Emaciation
a) Infants
b) Pre-School
children
3 .Marasmus
a) Infants
b) Pre-School
children
4.Total vitamin
a) Infants
b) Pre-school
children
5.Total "B" Complex
deficiency
a) Infants
b) Pre-school
children
Madhya
Pradesh
Orissa
West
Bengal
Uttar
Pradesh
231
268
652
688
3.0
-
0.3
1.3
0.7
0.5
-
-
0.4
0.9
—
4.0
—
3.9
1.1
—
—
—
8.5
-
0.2
5.2
0.5
1.1
1.4
—
-
3.3
3.0
—
2.6
1.0
1.6
0.6
4.6
4.7
—
—
—
0.7
0.6
0.5
2.3
-
3.4
-
0.9
-
0.7
—
_
—
—
—
—
—
—
—
—
0.7
4.7
2.3
4.9
0.8
1.6
1.6
5.6
2.1
5.6
0.9
1.0
_
0.6
_
_
—
—
6.6
10.3
13.3
0.8
2.4
0.5
7.7
2.7
-
1.0
8.5
10
of Vitamin A deficiency identified is 5.6 per cent among pre school
children in Orissa whereas the maximum prevalence of B Complex
deficiency is 13.3 per cent in Andhra Pradesh.
EARLY STIMULATION
There is ample evidence to show that environmental, cultural
and psychological stimulation are necessary for the child to realize
his potential.
However, the need for providing such opportunities
to children is not fully understood by families from weaker sections
due to ignorance, cultural and socio-economic realities.
Recognizing
this need, non-governmental agencies started kindergartens, Montessori
centres largely in Metropolitan cities and urban areas which catered
mainly
to upper socio-economic groups.
The under-privileged from
tribal areas, backward areas and urban slums did not have access to
such programmes.
Keeping this in view, the Government integrated
pre-school education with ongoing nutrition programmes.
It has been estimated that pre-school education covers hardly
1.2 million children which is about 1.5 per cent of the total
population in the age group 3-6 years.
Therefore, there was a need
to make the communities aware to send children to pre-school programmes.
ICDS,
to a large extent meets this requirement by providing access,
particularly to children of lower socio-economic groups in backward
rural and tribal areas and urban slums.
COMMUNITY HEALTH CEU
326, V Main, I Block
Korambngala
Bangalore-560034
Jndia
11
CHAPTER - III
PAST EXPERIENCE AND THE PRESENT SCHEME
The need for special attention to women and child welfare
as a part of ccnrnunity development has long been recognised in
India.
A massive increase in allocation has taken place over the
period covered by the 6
Development Plans.
The allocation for
social services and related fields is as follows:
Allocation in
Billion Rs.
(at current prices)
As % of total
Plan Outlay
1st Plan
(1951-55)
4.77
23.1
Ilnd Plan
(1956-61)
10.44
21.8
Hird Plan
(1961-66)
15.00
20.0
Annual Plans
(1966-69)
11.95
17.9
IVth Plan
(1969-74)
27.72
17.4
Vth Plan
(1974-79)
71.79
18.2
Vlth Plan
(1980-85)
148.36
15.2
Over the years, programming for children and women has
progressively shifted from a rehabilitative, correctional
welfare oriented approach to a broader developmental, preventive,
12
multisectoral one.
The adoption of the National Policy for
Children in 1974 gave a new impetus at the national and sub
national levels for sustained, broad-based, long-term, integrated
efforts to make children the focus of development.
Subsequently,
the Integrated Child Development Services Scheme (ICDS) was
initi aj-pd on an experimental basis but gradually expanded to
become the focal point for delivery of basic services to pre
school children.
This brief review of earlier programmes traces
the evolution of past experience which culminated in the formula
tion of the ICDS.
REVIEW OF PAST PROGRAMMES
The first systematic attempt at a programme for child
welfare was introduced in 1954 through Welfare Extension Projects,
administered by the Central Social Welfare Board.
It covered
activities for women too, and offered a package consisting of pre-primary
schools known as Balwadis,
limited supplementary feeding, health
services for children and mothers, first aid, recreation facilities,
adult education and training in arts and crafts.
Each project
covered 25 villages, and services were delivered at the village through
a
'gram-sevika' - a woman worker.
Another scheme was launched in
1967 called Family and Child Welfare Project with greater focus on
children and women.
The project was located at the Block or Taluka
level, with a Child Development Centre and Women's Welfare Centre.
They had sub-centres at key villages.
The resources allocated to these schemes were too mpagre
and the organisational base, particularly at the village level, was
too inadequate to make them a success.
Besides, a more integrated
approach to the needs of women and children was considered essential
as seen from seme of the evaluations subsequently
done of the scheme.
13
In particular, the 'Balwadis' were seen as potential centres
for the total development of the child and as a venue to impart
informal education to young mothers in child care, nutrition,
hygiene and family planning.
It was also realised that welfare
schemes undertaken independently of the general programme of rural
and community development were bound to suffer for want of
resources and continuity.
An organisational infrastructure for community development
was evolved during the First Plan with which child development
programme could well have been integrated.
An institution of
self-government at the local level to ensure community participa
tion in development efforts was evolved in the form of Panchayats.
The administrative machinery needed for rural development was set up
at the Block level, with a Block Development Officer in charge
and extension services were delivered at the village level through
the Village Level Worker (VDW) .
This machinery, however, was
mostly involved in increasing agricultural production.
It
nevertheless provided a framework with which additional inputs
could be integrated at little extra cost.
Health care programmes have been in operation in India
through the Department of Health since Independence.
They are
concerned mainly with immunization and the supply of drugs, vitamins,
iodised salts and iron.
Their aim is to reduce morbidity and
mortality rates among children as well as the general population,
but they rely more on curative strategies.
Primary Health Centres
were located at the Block level which is relatively distant from
the villages and approached in serious emergencies only.
So,
initially j-here was no adequate infrastructure for health check-up
and referral services at the village level, nor for educating
the villages in simple health care, even a vital matter like
diarrhoea management.
14
•
,
j-4 /-.n nnFri ■bi nn received oxsatfiir attention
During the seventies , nutrition reuexv
and several programmes were launched in different parts of the
country.
Almost all of them tried to promote health care,
nutrition and health and nutrition education.
The Special Nutrition Programme (SNP) which has been in
oppra-H on since the early seventies sought to reduce the
morbidity and mortality by raising the nutritional status of
children and nursing and pregnant women.
The latter were
covered because of the inpact expected on their children.
Though
health care programmes existed simultaneously in such blocks,
they were not integrated with SNP.
The Mid-Day Meal Programme
(MDMP) was designed to attract children to schools and encourage
regular attendance, in addition to raising their nutrition status.
Both SNP and MDMP were not exclusively restricted to the severely
malnourished children, but covered larger groups.
SNP,
in
particular, has been criticized as not being selective enough
in coverage, wasting resources which could otherwise have been
concentrated on the most needy.
The Tamil Nadu Nutrition Project (TNP) supported by the
World Bank, combines health services with nutrition inputs and
informal health-and-nutrition education.
Its main aim is to reduce
mortality and morbidity.
The nutrition programme is restricted to
the severely malnourished.
Children qualify for entry into the
feeding programme if they suffer from third-degree nelnourishment.
They mist exit once their nutritional status approaches normalcy.
But the rehabilitation is often temporary because poverty, rather
than ignorance about nutritional needs, is the main cause'of
malnutrition.
These programmes - SNP and TNP particularly, are not
concerned about larger issues of self reliance in food or
15
stimulating local production to meet the needs of fped i ng
programmes.
SNP receives donated food fran CARE and WFP,
and
TWP has been in operation through World Bank loan assistance.
The Applied Nutrition Programme (ANP) tried to raise
the nutritional status of children and women by actively
encouraging local production of foods needed.
Unfortunately, not
enough attention was paid to administrative monitoring and other
aspects of the infrastructure.
As a result, the necessary co
ordination and integration between different services did not
develop.
MAJOR WEAKNESSES OF THE EARLIER SCHEMES
The programme components of the schemes dealing with women
and children did not correspond to the specified objectives.
One
of the major lacunae in the preparation of the projects was the
absence of detailed project formulation, and inadequate emphasis
on
developing monitoring and feed-back systems.
Furthermore,
the financial resources provided for these projects were so
limited that the objectives were beyond the realm of realization.
Even though
the schemes envisaged voluntary support and community
participation in
all aspects of programme,
upon inpiementation, this
proved to be much less than expected.
gains of the programmes
In spite of the limitations, the schemes succeeded in
creating general awareness about the need for welfare services
and developed the organizational base for child welfare programmes
in rural areas.
The training institutions established to meet
personnel demands of these schemes upgraded the existing level
of skills of the middle level and field level workers.
16
REVIEW BY THE PLANNING OOMMISSICN, 1972
In 1972, two major reports prepared by the Committee on
the Pre-school Children's Feeding Programme, appointed by the
pi Arning Carmission,
and by the study group on the development
of pre-school chi Idrpn, appointed by the Ministries of Education
and Social Welfare, stressed the need to develop
child care services.
integrated
In response, the Planning Cormission set
up eight teams composed of representatives from the Ministries
of Education, Health, Rural Development, the Heme Ministry and
the Planning Commission, to visit various rural, tribal and
urban blocks and observe the organisational structure and the
reach of services to children in these areas.
The teams recommended an integrated package of services
to be delivered at the village level.
They further recommended
that the scheme should:
i)
fully utilize the existing government infrastructure
in the blocks;
ii)
involve local communities to the extent possible;
iii)
provide supplementary feeding and pre-school
education services to the poorer sections
of the population;
iv)
establish a non-formal pre-school infrastructure
as an entry point for health and nutrition
services.
It was further suggested that the programme should be
started on a modest scale and expanded after evaluation.
Subsequently, a working group was selected by the Planning
Carmission, comprising representatives from the Ministries of
Health and Social Welfare to formulate a schema based on the
reports of the study teams.
1
17
i
The Integrated Child Development Scheme is the result
of their deliberations.
■
INTEGRATED CHILD DEVELOPMENT SERVICES SCHEME
ICDS was initiated in 1975-76 on an experimental basis
in 33 rural, tribal and urban Blocks.
i)
Its major objectives are to:
reduce malnutrition, morbidity and mortality
of children in the age group 0-6 years;
ii)
improve their health and nutritional status;
iii)
provide the environmental conditions necessary
for their psychological, social and physical
development;
iv)
enhance the ability of mothers to provide
proper care to their children;
v)
achieve effective co-ordination among various
departments providing developmental services
to children.
To achieve these goals a package of services consisting of the
following was introduced:
a)
supplementary feeding;
b)
inmunization;
c)
health check up;
d)
referral services;
e)
nutrition and health education;
f)
pre-school education; and
q)
non-formal education for women
18
ite type of services to be provided for target groups are
as follows:
Service
Beneficiary
1.
2.
3.
4.
Expectant and
nursing mothers
Other women
15-45 years
Children less
than 3 years
Children between
3-6 years
(i)
Health check-up
(ii)
Immunization of expectant
mothers against tetanus
(iii)
Supplementary nutrition
(iv)
Nutrition and health
education
(v)
Functional literacy
(i)
Nutrition and health
education
(ii)
Functional literacy
(i)
Supplementary nutrition
(ii)
Immunization
(iii)
Health check-up
(iv)
Referral services
(i)
Supplementary nutrition
(ii)
Immunization
(iii)
Health check-up
(iv)
Referral services
(v)
Non-formal pre-school
education
19
ORGANIZATIONAL SET-UP
The Ministry of Social Welfare is responsible for the
budgetary control and administration of the scheme from the
Centre and co-ordinates activities with the Ministries cf
Education, Health, Family Welfare and Rural Development.
At the State level, the Department of Social Welfare
is mainly responsible, although in seme States, other
Departments, (e.g. Tribal Welfare, Women and Child Welfare,
Health or Rural Development) may take primary responsibility
for implementation.
At the Block level, the Block Development Officer
(BDO) exercises overall responsibility for the project, co-ordina
ting activities with the main ICDS functionary, the Child Development
Officer (CDPO).
As for the functions of other departments
in the Block, see Table III.
20
TABLE - III
ADMINISTRATIVE SET-UP OF ICDS SCHEME
Union Ministry of Social Welfare at the Centre
Department of Social Welfare in the States
Social Welfare Officer or Development/Planning Officer in District
Proj ect/Block/Ward
F
■ ■ 1
Primary Health Centre
(PHC) Doctor
Child Development
Project Officer (CDPO)
Lady Health Visitor (LHV)
Public Health Nurse (PHN)
Supervisors
Anganwadi Workers (AWW)
Sub-Centre/Auxiliary
Nurse and Midwife (ANM)
Helper
Block Development
Officer (BDO)
21
COMMUNITY K ■ .
326, V Mein, I Block
koraWfcno jla
Bangalore-56003‘4 *
India
ANGANWADI
The focal point for the operation of the ICDS at the
village level, is an anganwadi.
It covers a population of
about 1000 in urban and rural
areas and 700 in tribal areas.
The worker who co-ordinates and offers the services is the Anganwadi
Worker (AW'?).
Seme of the inportant tasks to be performed by the AWW
are as follows:
1.
to survey the community and identify child and mother
beneficiaries;
2.
to monitor the growth of children using weight for age
and identify children suffering from malnourishment;
3.
to maintain growth charts and records of attendance,
immunization, births, deaths, etc. at the anganwadi;
4.
to provide supplementary feeding to children;
5.
assist the IHV in distributing Vitamin A to children
and iron and folic acid supplements to pregnant and
lactating women; and refer patients to local health
services;
6.
to teach non-formal pre-school education to 3-6 year
old children and functional literacy classes for
adult women;
7.
to make hone visits in order to enlist ccmnunity and
beneficiary support to various activities;
8.
to organize women's clubs (mahila mandals) as fora
for health and nutrition education and centres for
income-generating activities.
22
HEALTH STAFF
For the projects sanctioned upto 1981-82, extra personnel,
both medical and para-medical, are provided in the project areas
fran the LCDS budget.
At present, the Ministry of Health and
Family Welfare is providing 100 per cent
central assistance to
upgrade the health set-up to nationally accepted norms.
Therefore,
in rural/tribal ICDS projects sanctioned fran 1982-83 onwards, no
extra health personnel are needed.
However, in urban projects, one
doctor and four para-medicals will be provided from the LCDS
budget.
CO-ORDINATION AT DIFFERENT LEVELS
The scheme provides for co-ordination cormittees at the
district, block and village levels to ensure smooth inpiementation
of the scheme and to elicit corrnunity participation and support.
At the district level, the District Collector, District Magistrate,
or Chief Executive Officer, chairs a conmittee composed of district
level officers with representatives of the Indian Council of Child
Welfare (ICCW), State Social Welfare Board (SSWB) and Voluntary
Organizations.
Co-ordination Committees at the block and ^ri 11 aga
levels are composed of concerned officials, representatives of
the Panchayati Raj Institutions and community leaders.
The CDPO,
directly in charge of the scheme, directs activities at the
project level in collaboration with the supervisors and anganwadi
workers.
MULTI-SECTORAL APPROACH
The goal of ICDS is not merely to reduce morbidity and
mortality, but to lay the foundations for the proper psychological,
physical and social development of the child.
Insofar as it
involves improving the environment in which children live and
grow, ICDS could be viewed as a catalytic agent for community
23
development involving health, education, family planning,
stimulation to the local econcmy and participation of the
cm i si unity in its own development.
The goals of this programme
are thus more comprehensive without sacrificing the urgent goal
of reducing morbidity and mortality.
The scheme attempts to
achieve these goals by co-ordinating the efforts of various
Ministries at the central , state, district and block levels.
FINANCIAL OUTLAYS FOR ICDS PROJECT
The annual total cost of a rural and tribal project upto
1981-82 has been estimated at Rs.0.64 million and Rs.0.38 million
respectively.
For the projects sanctioned fron 1982-83, this
has been revised to Rs.0.53 million and Rs.0.31 million.
annual cost of an urban project is Rs.0.75 million.
The total
The table
below presents the break-up by major items of expenditure.
Table IV:
Financial Outlays for ICDS Projects*
Tribal
Rural
(Rs.
Projects upto 1981-82
Urban
Million)
Staff
0.34
0.12
0.36
Strengthening PHC/
sub-centre staff
0.44
0.26
0.41
Recurring costs
(medicines, POL, etc.)
0.10
0.06
0.24
Non-recurring cost
0.10
0.06
0.10
Total provision
0.64
0.34
0.75
*
This excludes the cost of providing supplementary nutrition which
is an additional Rs. 0.93 million per year in rural and urban
projects and Rs. 0.61 million per year in tribal projects.
24
Table IV: Financial Outlays for ICDS Projects (Contd.)
Rural
0.31
0.53
Exceeds pro
vision of
0.10 for
health
staff and
0.001 for
rent of
building
for
medical
and para
medical
staff
Does not
provide
0.7 for
health
staff
and
0.004
for
rent
The unit cost per beneficiary in a project per year
sanctioned upto 1981-82 excluding supplementary nutrition is
Rs.27.28 in rural areas, Rs. 44.00 in tribal areas and
Rs. 33.29 in urban areas for 17000 children in rural/urban
project and 6000 children in tribal project.
In the projects
sanctioned from 1982-83, the unit cost per beneficiary in an
urban project is Rs. 44.22 whereas for rural and tribal
projects it is Rs. 37.35 and Rs. 63.60 respectively.
following table shows the service-wise costs in these
projects.
Urban
(Rs. Million)
Projects after 1982-83
Revised provision
Tribal
The
Remains
the
same
25
V:
Service-wise Cost per Beneficiary
Service
Health
Vfelfare
Compo
Conponent
nent
Rupees
Total
Nutrition
Component
Sanctioned upto 1981-82
4.58
22.70
27.28
75.00
Sanctioned from 1982-83
8.00
29.35
37.35
75.00
Sanctioned upto 1981-82
2.82
30.47
33.29
75.00
Sanctioned frcm 1982-83
6.11
38.11
44.22
75.00
Sanctioned upto 1981-82
8.00
36.00
44.00
75.00
Sanctioned from 1982-83
14.60
49.00
63.60
75.00
Projects
Rural
Urban
Tribal
26
CHAPTER - IV
ASSESSMENT! CF ICDS
Fran the outset, the Government of India recognized the
need for a regular monitoring system and for periodic evaluation
of the programme.
The Programme Evaluation Organization (PEO)
of the pi arming Commission conducted a bench-mark, survey in 1976
and a repeat survey in 1976-1978.
The main emphasis in both
surveys was on the state of preparedness, the reach of services
and opinion/attitudes of beneficiary families.
The process of
implementation, not the impact, has been the focus of PEO surveys
and evaluations.
At the same time, a monitoring cell was
established at the All India Institute of Medical Sciences (AIMS)
to review the medical and nutrition inputs into ICTS.
Drawing
on the assistance of medical colleges, and a cadre of especially
trained medical consultants, the AIIMS has surveyed the above
inputs and has issued periodic reviews of progress in the
area of health and nutrition and related them to perceptible
demographic changes in the beneficiary population.
Attempts to develop a monitoring system covering the
social inputs into ICDS have not been very successful.
At this
point, no effort is under way to systematically review or evaluate
the impact of these components, including the highly visible pre
school component, on the well-being of children.
Existing studies
and reviews of ICDS, therefore, tend to take a limited view of the
programme and assess it entirely in terms of health and nutrition.
Recently, several attempts have been made to compare ICDS to
other health and/or nutrition programmes disregarding the fact
that it is an integrated programme equally concerned with the
social and cognitive development of the child and with upgrading
the physical environment of the family.
redress the imbalance.
This study attempts to
27
OBJECTIVES OF THE ASSESSMENT STUDY
The specific objectives of the assessment are:
i)
to review the overall functioning of the scheme
at the village level;
ii)
to assess the effectiveness of the delivery of
services;
iii)
to determine the effect of services on attitudes,
general awareness and daily practices in the
local community;
iv)
to assess the benefits against resources invested
in the programme.
METHODOLOGY
Nine teams were organized to collect data including groups
and individual researchers from the Tata Institute of Social
Sciences (Bombay); the Department of Child Development, Agricultural
University (Haryana) and the Institute of Heme Economics (Delhi).
The teams consisted of experienced research staff taken on short
term deputation.
In all, 16 blocks in the states of Andhra Pradesh, Karnataka,
Rajasthan, Maharashtra, Haryana, Uttar Pradesh, Nagaland, Bihar and
Delhi were selected for the study.
Only those blocks where the
programme was initiated during 1978-1979 and 1979-1980 were
gplpM-pj. the rationale being that these blocks had a reasonable
amount of time to establish the programme.
Of these blocks, six
are from rural, four from tribal and three from urban areas.
Data was collected from 124 villages selected at random.
village, five beneficiary families were selected
In each
from the list
of households eligible for assistance and 620 respondents were
interviewed.
In addition, either the Panchayat President or a
28
member
was interviewed.
Details regarding the states and blocks
selected are given below:
ICDS STUDY - 1983
Name of
State
Name of
Block
Type of
Block
Name of
District
1.
Karnataka
Kanakpura
Hunsur
Rural
Rural
Bangalore
Mysore
2.
Andhra Pradesh
Ethunagaram
Dcmakonda
Tribal
Rural
Warangal
Nizamabad
3.
Rajasthan
Chottisadri
Rajasmand
Tribal
Rural
Chittorgarh
Udaipur
4.
Maharashtra
Wbrli
Talasari
Urban
Tribal
Bombay
Thane (Bombay)
5.
Haryana
Kalayat
Beri
Rural
Rural
Jind
Rohtak
6.
Uttar Pradesh
Sohawal
Rural
Faizabad
(base study)
7.
Bihar
Khunti
Tribal
Ranchi
8.
Delhi
Jehangirpuri
Kalyanpuri
Urban
Urban
Delhi
Delhi
9.
Nagaland
Phek
Jalukie
Tribal
Tribal
Three questionnaires were distributed.
information
The first sought
on the cleanliness of the anganwadi, provision of toilet
facilities, stimulation and comprehension
participation in
ancng children, ccrmrunity
the anganwadi, contribution by families, individuals
philanthropists and voluntary agencies.
29
The second questionnaire was used to collect demographic data
such as the population, children in the age groups of 0-3 years and
3 6 years, numbers enrolled for nutrition supplementation and
children with severe malnutrition.
The third was used to assess the
opinions and attitudes of the beneficiary families concerning the
efficiency of the programme, family planning, family size and illnesses
among children.
RESULTS AND ANALYSIS
I
Staffing
The staffing pattern in the various surveyed projects is as
follows:
Table VI:
Position of staff in the surveyed projects
TYPE OF PROJECTS
Tribal
Rural
Category
of Staff
Sanc
In
tio
posi
ned
tion
Total
Urban
Sanc
tio
ned
In
posi
tion
Sanctio
ned
In
posi
tion
ned
In
Posi
tion
Sane-
CDPO
6
6
4
4
3
3
13
13
Mukhya Sevika
Supervisors
26
20
24
22
10
8
60
50
Doctor
6
6
4
3
2
2
12
11
lhv/afm
48
44
29
15
12
12
89
71
526
453
321
301
300
300
1147
1054
AVW
n r
The data represents information from 13 blocks.
Data from one rural block is not available.
30
f
These figures indicate that given adequate time for training
and organization, the staffing is fairly well distributed although
there is a perceptible problem in staffing the grassroot—level
workers in both rural and tribal areas.
several factors.
This is attributable to
The workers , all of Whom are female, must contend
with inadequate transportation, long distances and the constrictions
imposed
by traditional values.
II
Programme Beneficiaries
1.
Age Group
In the projects surveyed, 13.4 per cent of the rural, 14.6 per
cent of the tribal and 14.8 per cent of the urban population fell
in the age-group 0-6.
The projected coverage in the schematic pattern
prepared by the Ministry of Social Welfare for the age group 0-6 estimated
this group to include 17 per cent of the total population which is
nearly 2 per cent more than the observed demographic
distribution.
The percentage of the population in the vulnerable 0-3 age group
was 5.9 per cent in rural, 6.7 in tribal and 12.4 in urban areas.
Changing demographic trends, falling birth rates and improved health
care facilities account for the difference between estimated and actual
figures (Annexures 1 & 2).
Children in the age group 0-3 years account for almost 50%
of the total enrolment in supplementary nutrition which is considerably
more than the 35.4% reported in the Repeat Survey of the PEG (p.61)
based on 1976-1978 data.
The programme has considerably improved its
capacity to reach this vulnerable group of young children who have
to be carried to the centres by their mothers or older siblings.
2.
Coverage of schedule tribe and schedule
caste families
A substantial number of children attending the programme belong
to scheduled castes and scheduled tribes (Annexures 6 & 7) which is in
line with the findings of the PEG Survey (page 60) .
A significant
31
number of children from the TO sections of the society are
enjoying the benefits of the scheme.
to the location
This is partly attributable
of centres based on the distribution of population
obtained from the baseline surveys.
In sane cases this has
discouraged the participation of the more privileged group in the
communities, who are bound by caste barriers, fran pm-H pat-i ng
actively in the anganwadi.
Similarly, larger numbers of pregnant
women caning fran poor families are availing themselves of the
services.
Of the 1975 pregnant wonen enrolled, 466 are fran
scheduled castes and 653 fran scheduled tribes (Annexure 4).
3.
Attendance in the anganwadis
The highest percentage of children attending anganwadis is in
tribal blocks (63.2%) followed by urban areas (49.7%).
The percentage
of girls attending the anganwadis is almost 48% and is the highest
in tribal projects (49.8%).
Geographical and demographic factors
impose a different pattern on the scheme in tribal areas, where the
anganwadi centres serve smaller populations, thereby fostering
better cormunity contact and increased participation.
4.
Birth and death rates
Basic information on birth and death rates is not available
in all villages, only 103 centres reported births.
The reported
births are around 15 per cent in rural and tribal areas and 24.9
for urban areas.
Similarly, reported death rates for rural, tribal
and urban areas are 3.4%, 4.53% and 2.43%, respectively (Annexure 8).
There is a wide
maintained
variation in the records of births and deaths
by anganwadis and village panchayats.
The birth and death
rates seem to be half of the corresponding state averages for rural
and tribal villages although those of urban centres seem to correspond
to the national average.
low.
Likewise, the reported death rate is very
The disparity in reported figures could be due
to under
reporting of births and deaths in the villages, inadequate training
of the anganwadi workers and the difficulty in obtaining accurate
data at the village level.
32
III
Progranrne delivery
1.
Immunization
Timm mi 'zati on is the first step in combating infant mortality.
Inrnunization against the major childhood illnesses is carried out by
the health personnel attached to the scheme (Annexure 9).
In the case
of polio, there is a 33 per cent drop in coverage from the first dose
to the second dose and a 31 per cent drop from the second to the
third.
There is a need for closer monitoring by health personnel
to ensure that the whole series is administered to children.
2.
Supplementary nutrition
Supplementary nutrition is provided to raise the nutritional
status of young children in general and to coirbat the adverse effects
Out of 11,443 children covered by the Survey, 502 or
of malnutrition.
4.5% have been identified as malnourished.
Of these, 258 are girls
and 244 are boys (Annexures 2 & 3), an unexpectedly even balance.
The
regularity of feeding and the kind of food provided differs from
centre to
centre.
In 64 per cent of the centres food is available
for the prescribed 300 days a year (Annexure 5) whereas in others it is
provided for only 150
to 250 days.
In 52 per cent of the cases, food
is cooked on the premises; in others, ready-to-eat food is provided.
In tribal and rural areas, cooking is usually done at the anganwadis.
Only 24 per cent of the centres use fresh vegetables in the cooking.
This is often provided by the community.
3.
Functional Literacy for Mult Vfcamen
Attendance
(Annexure 10).
in the functional literacy classes is very lew
The maximum drop out occurs between the time of the
initiation of the programme and the fifth month of implementation.
The main reasons for dropping out are (i) women find no spare time to
attend the classes; (ii) anganwadi workers show little interest in
the classes;
(iii) lack of facilities at the centre; and (iv) the
programme is not considered of much use by the village women.
33
Observations of the Research Team
Cleanliness and personal hygiene
Of the 124 anganwadis surveyed by the research team, 80 centres
(65 per cent) have clean surroundings.
Of these, the centres located
in rural areas are the most clean, followed by tribal areas.
44 centres (33 per cent) have toilet facilities.
Only
The personal hygiene
of the children, hair and dress, at the anganwadi is decidedly poor
(Annexures 11 and 12).
There is considerable scope for improvement
in both environmental and personal hygiene.
(ii)
Corprehension and cognitive development in children
The children are able to identify the animals, fruits,
vegetables, sing songs and, in sane cases,
rudiments of numeracy.
The alphabet
have acquired the
is taught in many centres.
The
overall responses on cognition and canprehension are quite satisfactory
(Annexure 13).
(iii)
Carmunity Participation
About 53 panchayats or 92 per cent of those surveyed had
made some contribution to the programme.
Contributions were mostly
in the form of land, buildings and firewood.
contribute to the centres.
Families do not generally
Of those interviewed, only 10 per cent
had made sore contribution to the programme.
The contribution is in
the form of food conmodities, firewood and labour and is on an
irregular basis.
Contributions by individuals and philanthropists
are negligible.
Nd contribution by voluntary agencies directly to
anganwadis were reported (Annexures 12 & 13).
(iv)
Coordination Committees at the village level
Co-ordination Conrnittees were only set up in 57 of the
124 villages.
Conmittees are composed of mostly school teachers,
34
panchayat presidents and village elders.
Adequate representation is
given to non-official members wherever the committees have been
constituted (Annexure 16).
The corrmittees meet more often in tribal and urban areas
and records of discussions are maintained in sone 45 centres.
The
Hismi.esHinns concentrate on day to day inpiementation decisions
(Annexure 17).
V
Opinion of the beneficiaries
1.
Family planning and size of the family
Nearly 60 per cent of the beneficiaries are in favour of
family planning.
The majority favour three children and a
comparatively high number of the beneficiary families questioned
reported having 3-5 children.
This indicates a perceptibl a change
in attitude and acceptance of family planning programmes in the
project areas (Annexure 18).
2.
Knowledge of respondents on immunization, health
check up, pre-school education and supplementary
nutrition.
Most of the respondents, almost 80 per cent, are aware of
the benefits of immunization and take advantage
of the 70 per cent
of health check ups provided by the centre and the local PHC.
Most
of the respondents know of the services available through the scheme —
pre-school education, supplementary nutrition, vitamin A distribution
and functional literacy classes (Annexure 19).
because it prevents diseases.
Immunization is accepted
However, very few are able to connect
imnunization to the growth of the child (Annexure 20).
Of the 598 respondents, 55 per cent are aware that the
programme includes vitamin and iron distribution
but only 24 per cent
were able to identify vitamin A with the prevention of blindness
Oily 18 per cent stated that vitamins help the growth
of the child
35
and prevent diseases.
Responses to questions regarding supple
mentary nutrition indicate that it is widely known to help
grosvth but the connection between malnutrition and disease is
not fully understood (Annexure 21).
Most of the respondents are aware of the existence of
the pre-school programme and see it as a positive step towards
formal education.
The concepts of mental growth and early
stimulation are not fully understood.
The Functional Literacy for Adult Women programme is
equally well-known to the beneficiaries.
Seme view it as a
programme which helps women to learn and acquire skills
(Annexure 22).
However, the skills often demanded are income
generating skills which are not an established part of the
curriculum.
3.
Carrnunity Participation
About 50 per cent of those questioned said that they
would consider contributing to the programme and that they are
able to provide grain, firewood and labour.
There was, however,
a marked difference between the responses of urban communities
and those located in rural and tribal areas, confirming observa
tions from previous studies that the urban poor are unwilling or
unable to contribute materials or labour to the centres (Annexure 23).
4.
Health status: Incidence of illness
Thirty per cent of respondents stated that their children
had fallen ill during the last 15 days.
The incidence of illness
is higher in rural areas and has an average duration of 3-5 days
of fever, respiratory ailments and diarrhoea (Annexure 24).
majority (91 per cent) reported illness during the last year.
The
Fevers
and diarrhoeal episodes recur most frequently and again, the incidence
is higher in rural areas (Annexure 25).
36
CHAPTER - V
AN ANALYSIS OF BENEFITS AND RESOURCE INVOLVEMENT
The indirect and long-term economic benefit of social welfare
programmes does not lend itself to the
more common economic appraisals
of cost-effectiveness and social benefit/cost analysis.
Instead
of trying to assess what long-term impact such schemes have on
GNP and appraise them in terms of such an impact, one could
legitimately ask whether efforts and cost involved in raising GNP
are worth undertaking in terms of improvement in the quality of life1.
Attempts have been made to employ tools of cost effectiveness
in the appraisal of social welfare projects, whose benefits cannot
be quantified.
Given a particular goal, like the reduction of
infant mortality, an exercise could be carried out to assess and
select the most cost-effective method of attaining it.
But it is
meaningless to isolate one variable from a project with multiple
or comprehensive goals and, merely for the sake of gnm-ifif-jcat-ion,
compare it with the same variable isolated from a multi-sectoral
programme with different goals.
In other words, it would not be
logical to compare the cost of saving one life through a
1.
Knudsen's study of supplementary feeding in the Tamil
Nadu Project, for example, found that the Project was
viable and economically justifiable in the sense that
the social rate of return was above the opportunity
cost of capital. This outcome depends on at least
a 10 per cent improvement in mortality rates (and
consequent reduction in wastage and enhancement of
earning) and a 10 per cent increase in productivity
following improved health and nutritional status.
Odin K. Knudsen - Economics of Supplemental Feeding
of Malnourished Children, World Bank Staff Workina
Paper No. 451, 1981.
g
programme which is concerned merely with immunization, health
care and diarrhoea management to reduce mortality, with one
saved through a programme concerned with the psychological,
physical and social development of chi Idrpn, in addi-bion to
providing health care.
Instead of carrying out comparative
exercises which are not quite meaningful, we shall try nevertheless,
to indicate various economic and social benefits of Tens,
and have an idea of the resource involvement and efforts needed
to make the Scheme more effective in achieving its goals.
Since the ICDS Scheme was launched on an experimental
basis in late 1975, and has only recently been significantly
extended, it is too early to identify any impact on infant
2
mortality.
However, the evaluations carried out by the PEO
and by Prof. B.N. Tandon of the All India Institute of Medical
Sciences, show encouraging results.
Prof. Tandon's study
showed that in two separate samples drawn from groups of the
same socio-economic level, more children received immunization
and nutrition services in areas that had been covered by ICDS
for 3 years (sample C), than in areas depending on the regular
services (Tenceb., Jan.15, 1983, p. Ill).
The relevant data is
presented in Table VII.
2.
PEO, Planning Cctrmission - Evaluation Report on the
Integrated Child Development Services Projects 1976-78, Government of India, New Delhi, 1982.
38
TABLE VII:
Receipt of Essential Health Services and
Nutrition Status (1979-80) - Percentages
of Children
________________
NON-ICDS
ICDS
Sample B
Sample C
BCG
17.4
43.6
DPT
14.0
35.4
Poliomyelitis
9.2
Not recorded
Health Check-up
15.3
61.3 (57.7)
*
Vitamin A
17.7
57.1 (52.7)
*
Supplementary Nutrition
26.0
55.5
Normal + Grade I
56.2
62.7
Grade II
28.2
26.2
Grades III + IV
15.1
10.8
Not recorded
0.5
0.3
Services from
Imnunization
Nutritional Status
* Data for 4 urban projects not included
Tandon et al, Lancet, Jan 15 1983, p. 110
Source:
ICDS has been relatively successful in reaching the poorer
groups in isolated as well as urban areas.
Still, according to the
PEO, only 62 per cent of children from poor families are covered
by ICDS.
There seem to be
two factors behind this.
Very poor
families are inhibited by the fact that their children have no
39
proper clothes, even by village standards, to attend anganwadis,
either for feeding or for non-formal education.
The second factor
is that where there are younger children at hone, pre-sahoolers
are required at heme to look after them, while adults can work.
Seme anganwadis overcame this problem by permitting pre-schoolers
to bring their younger brothers and sisters to anganwadis.
If the
anganwadis are kept running for sufficiently long time to al low
adult women to work, it provides an important, though indirect
benefit to them, in increased income and production.
The ICDS
can thus be a good complement to anti-poverty programme in more
ways than one.
The pre-school non-formal education provided by ICDS
removes an important disparity between rural and urban areas, and
within urban areas, between the rich and the poor.
Only the
urban rich and the middle class can afford the preparatory and
kindergarten schools which prepare children for the school.
Such
facilities do not exist in rural areas or for the urban poor.
This
has been related to the high dropout and failure rates among older
children from poor backgrounds.
The ICDS Scheme fills this gap,
a-j-braci-ing children through its nutrition programme.
In this
context, it is impractical to restrict nutrition programmes to the
severely malnourished.
There are many poor children who are not
malnourished and need to be oriented to schooling.
The cost of
feeding the children from non-poor families could be recovered
in the form of a tax levied by village panchayats (local self-
governing bodies) on the better-off sections in villages.
An indirect, but significant benefit of the nutrition
programme, is the breaking down of social barriers for children
from scheduled castes, who are encouraged to attend the anganwadis,.
where they mix with others.
40
The Sixth Plan (1980-85) mentions that though 75 per cent
of children in the primary and middle
school age group are
enrolled in schools, about 38 per cent of scheduled caste children
and 56 per cent of scheduled tribe children are yet to receive
elementary education.
Unless these children receive a minimum
education, they will not be able to participate in the mainstream
of economic development.
The ICDS has, if properly implemented,
the potential not only to break down the isolation of such
children by attracting them to anganwadis, but also to help them
to develop themselves.
India has adopted the policy of "Health for All by 2000 AD"
and the ICDS is an important part of the strategy to achieve this
goal.
The Infant Mortality Rate, which was 126 per 1000 live
births in 1976, is expected to cone down to 60 by 2000 AD: the
crude death rate from 14.2 to 9.0; and the crude birth rate from
33.3 to 21.0 .
The reproduction rate should decline from 1.51
(in 1980) to 1.0.
Potentially, ICDS can play a larger role in achieving these
targets, by conplementing other programmes and contributing significantly
to human resource development.
Apart frcm this optimistic scenario, there are some direct
features with short-term benefits also.
It has the potential of
creating new avenues of socially productive employment.
If 1000
blocks (projects) are covered by 1985 as targetted, it would employ
85,000 wcmen as AWWs and another 85,000 women as their helpers.
It
would also employ 1000 Child Development Project Officers, 1000
Assistants, 3000 to 5000 supervisors, 1000 clerk-typists, 1000
drivers, 1000 peons, 1000 more doctors, 2000 lady health visitors
and 4000 to 8000 auxiliary nurse-midwives, not counting multiplier
effects on further employment created by this initial employment.
41
Most of the categories are those "manned" by wcnen.
This will have
an impact on the economy of families and on the birth rate.
The extra oost of creating an additional infrastructure
at the village level would appear ireagre on a per beneficiary
basis.
The cost of AWWs alone is calculated by Tandon et al
to be only Rs. 12 per beneficiary per year, over and ah-nzA the
cost of health services infrastructure.
The important point
that we need to note here is that considering the extra benefits
generated by the ICDS in filling vital gaps in development
programmes and in offering a co-ordinated package of services,
the extra cost invested appears quite meagre.
On the basis of financial allocations made by the Planning
Ccrrmission, we can have sane idea of the resource involvement.
It
is not possible to aggregate all costs on a per beneficiary basis
because the target population per block for health care is much
more than per target population for the nutrition programme.
The former is about 17,000 in each rural or urban project, whereas the
latter is only 6800 children and 1600 wonen.
The target
population for non-formal education in health and nutrition is even
rrore than that for health care.
The official scheme (as revised in
1982) provides details of the target population which are presented
here in Table VIII.
42
Table VIII:
~
Type of
population
covered
Target Population of ICDS Scheme in each
Project (Block) - Service-wise
Total Population
Service
Rural or
urban
project
Tribal
project
Target Population
Rural or
Tribal
urban
project
project
Children
Immunization
17,000
5,950
17,000
(100%)
5,950
(100%)
- do -
Health
Check up
- do -
- do -
- do -
- do -
- do -
Supplementary
nutrition
- do -
- do -
6,800
(40%)
4,462
(75%)
- do -
Referral
- do -
- do -
II
Children
(3-5 years)
Pre-school
education
8,000
2,800
*
4,000
(50%)
2,100
(75%)
III
Nursing &
expectant
mothers
Supplementary
nutrition
4,000
(2400 +
1600)
1,400
(910 +
490)
1,600
(40%)
1,050
(75%)
Expectant
mothers
Health
check up
2400
910
2400
(100%)
910
(100%)
- do -
Immunization
against
-do -
- do -
- do -
- do -
Vfcmen
15-45
years
Nutrition
and health
education
20,000
7,000
20,000
(100%)
7,000
(100%)
I.
IV
Note:
*
Source:
Wherever necessary
Figures in brackets are percentages of target population to the---------t?t±- ?^SCiarifu
selected as
guidelines issued by the Ministry
of Social Welfare; their actual number can differ from project to pro>rt
This appears to be lower than needed and is likely to be revised upwards
Ministry of Social Welfare, Government of India, ■’mtearated china
Development Services Scheme- (Revised July 1982) pp 17^
1
43
When the targetted population differs for different
services, it is difficult to assign costs service-wise.
The
very idea of an integrated scheme is to increase cost-effective
ness by combining dififferent services.
Thus the same AW provides
pre-school education, nutritional supplement, non-formal heal-t-fr
education to women and co-ordinates health services.
Keeping
these limitations in mind, we can express costs on a per
beneficiary basis only in the case of some components, but not
in the case of the total resources involved.
The resource involvement, ignoring non-recurring costs
for the moment, consists of three main components.
The health
component composed of salaries for the health staff, medicines
and related expenditure on health care.
The welfare component
mainly consists of salaries for other staff and contingencies
at the block and village level.
The nutrition component consists
only of food costs, which is supposed to be met by the concerned
state governments.
The cost of the first two components is met
by the central Government.
The details of financial allocations
for each project as per the revised scheme (1982) are presented
here in Table IX.
It also indicates costs per beneficiary in
each of the three components.
The recurring costs add upto Rs. 1.28 million for each
rural project, Rs. 1.40 million for each urban project and
Rs. 1 million for each tribal project.
Since the population
in a tribal project is smaller, the costs are lower.
Though
the populat-i <->n in rural and urban projects is assumed to be the
sane, rents have to be paid in the latter.
The buildings for
anganwadis are provided free by the village panchayats and
even where they have to be hired as in the case of buildings for
h<?A1t.h gt-aff, the rents
are lower in rural areas.
44
Table IX:
Cost estiirates of ICDS project (^ff^J9825
(Rs. in thousand in each project or block,
except in the case of per beneficiary costs
which are in rupees)---- --- ----- ------------
j
______________
Rural
Urban
Tribal
Salaries for health staff
Medicines
Rent
100
30
6
50
30
24
70
15
4
Sub total Health
136
104
89
8.00
Rs. 6.11
Salaries
POL maintenance etc.
Contingencies for
- Anganwadis
- at block level
Rent for anganwadis
(in urban projects only)
338
30
358
15
198
25
18
5
-
18
5
144
5
Sub total welfare
391
540
237
29.35
Rs.38.11
Rs.49.00
Children (normal) *
Expectant & Nursing
mothers (normal) *
Severely malnourished
children **
(extra cost over normal)
510
510 .
510
240
240
158
3
3
2
Sub total Nutrition
753
753
670
GRAND TOTAL
1280
1397
996
Item
I
Health
per beneficiary per year
II
Rs.
@
Rs.14.60
Welfare
per beneficiary per year
III
1
Rs.
9
Nutrition supplement (Food Cost)
@ for projects sanctioned upto 81-82 only
Note:
These refer only to recurring costs. NOn-recurring costs in supplies
and equipment are about Rs.200,000 for each Project.
**
J°r A00^3' at
°f 25 ^ise
da* (Rs-75 per year).
for 45-60 days only (60 days assumed here), tne additional fcod^upplenorraal ~eed costing 35 paise per child per day (Rs.21 in a year).
Such children are assumed to be 20% of the normal.
1
1
45
The lion's share of the total cost goes to the nutrition
supplement, which is Rs. 0.75 million per rural or urban project
and Rs.0.67 million per tribal project.
It amounts to 58 per cent
of the total recurring costs in rural projects, 54 per cent
in
urban projects and 68 per cent in tribal projects.
Assuming that, due to inflation and related factors, the
estimated cost by the end of 1985
will be 20 per cent higher and
assuming the cost of rural projects to be the average for all projects,
the total resource involvement (excluding non-recurring costs) for
1000 blocks by 1985 would only be Rs.1,540 million in 1985.
1982 estimates (without the inflation
Using
factor) and expressing it
as percentage of the average annual plan outlay for the Sixth Plan in
the public sector, the recurring costs for operating 1000 ICDS projects
would be less than 1 per cent (0.66 per cent to be more precise) of the
total budget.
As a percentage of Gross Domestic Product in 1979-80, it
amounts to a mere 0.13 per cent.
One could even legitimately argue
that considering the vital role of the ICDS project in stimulating
change at the community level and improving the quality of life, as
well as the GDP of the country and the committed outlay on planned
development, the resources allocated to ICDS are insignificant.
There
is scope both to extend the coverage of the scheme to more blocks
and to allocate mere resources for each project to increase its
effectiveness in achieving its goals.
As already noted, a cost comparison between different programmes
bristles with difficulties,
particularly if the costs are calculated
on a per beneficiary basis.
If the total project cost is considered,
the cost of an ICDS project is only marginally higher than the cost
of an SNP project, though the former has comprehensive goals.
The
total cost of an SNP project is estimated by the Planning Commission to
be Rs.1.04 million in rural areas, as against
Rs. 1.28 million for
46
If the data presented by David Sahn
*
an ICDS rural project.
in
his report to USAID in 1980 is to be taken as a guide, the cost per
project per year in the Tamil Nadu Nutritional Programme is much
ICDS project.
higher than that of an
The Tamil Nadu project cost
varied from Rs.11 to 40 million per year.
Apart from recovering seme of the costs as proposed above
of feeding the children from the ccmnunity, there are other means
of economizing while increasing the effectiveness of ICDS.
One
would be to restrict the expansion of the programme to the poorest
and most backward geographical areas though,in the process, the poor
in more developed areas are excluded.
Such a policy is justified
since the poverty of the individual household is not the only variable
determining morbidity and the child's nutritional status.
Environment conditions contribute to the fact that the
poor in more developed areas are generally better off than the
poor in less developed areas.
This is not to suggest that poverty
is a regional rather than an inter-personal or inter-class phenomenon,
but to note that the spatial dimension of poverty is an -impm-j-ant-
consideration in planning the geographical coverage of child
development prograiunes.
Another consideration is that poverty or hunger is not a
constant phenomenon.
It
has a seasonal character and in lean
seasons when employment and even wage levels may be lower, the
landless face more hunger.
wet seasons,the
When lean seasons coincide
with the
incidence of morbidity is also higher, requiring
* Sahn, The Integrated Maternal & Child Nutrition Project IndiaRecommendations based on a review of Past Experiences 1980, p^H5
47
health care and nutritional assistance.
Apart from the seasonal
factor, there are fluctuations in agricultural conditions which
dictate econanic conditions.
In drought years, enhanced feeding may
be needed with corresponding reductions in good years - good both from
the point of view of output and market conditions.
Anganwadis are instituted only in villages with a population of
1000 or more.
even
Small villages are not often in a position to provide
the minimal ccmrtunity support required.
The scheme thus
bypasses snail isolated villages which may actually be poorer than
larger villages.
The importance of size in rural development has
been recognized and a cluster approach to rural development is now
being tried in India.
Attempts must be made to bring the benefits of
ICDS to smaller communities.
If the cereals, pulses or other food used for supplementary
feeding are locally procured, it would be possible to procure much
1 arger quantities with the same resources.
local production.
It may also stimulate
Bureaucratic rules, however, dictate that foodstuffs
must be procured only through a public distribution system.
If a
local coirrnittee is formed to look after anganwadis on an honorary
basis, it can be empowered to procure food at the least possible
cost, provided the prices in no case exceed
by the public distribution systen.
the prices offered
Such a committee can be
encouraged to procure food outside the market system, specially
meant for anganwadis.
48
CHAPTER - VI
SUMMARY AND CONCLUSIONS
The ICDS scheme embodies the summation of previous experience
in India to promote the welfare of the young child bom into socially
and economically disadvantaged circumstances.
Welfare programmes
initiated in the 5C's, 60's and 70's have been carefully analyzed to
avoid duplication of unsuccessful efforts and to learn from positive
experience.
A comparison of ICDS with earlier Child Vfelfare Schemes
reflects this effort.
BENEFICIARIES COVERED —
Evaluations of earlier schemes reported
the limited coverage of the services.
The ICDS is area-based and
designed to provide comprehensive coverage to all children in a block
with special emphasis on reaching under privileged groups.
By the end
of the Sixth Plan in 1985, ICDS is expected to provide 10.30 million
children with immunization and health check-ups; 6.1 million children
and 1.1 million women with supplementary nutrition and 3.4 million
mothers with non-formal education classes.
ORGANIZATIONAL STRUCTURE
—
Previously, the BDO at the block level
was in charge, since his work-load and responsibilities encompassed
all aspects of overall rural and agricultural development, child
welfare received little attention.
In ICDS, the organizational
structure was strengthened by providing the posts of CDPO and
supervisory staff.
DELINEATION OF RESPONSIBILITIES
—
The responsibility for the delivery
of health, welfare and other services was not clearly identified at
the field level in earlier projects, leading to inadequate delivery of
services
from ether departments, particularly health.
This was
49
into consideration at the planning
phase and attempts were
de to allocate responsibilities to each department.
For instance,
the health department provides health inputs and the anganwadi worker
is expected to assist the ANM and effect co-ordination at the
village level.
FINANCIAL INPUTS
The provision of medicines, equipment, personnel
and other recurring and non-recurring costs were inadequate in ea-rl i pr
schemes.
The ICDS inputs were carefully identified and recommended
by the eight Study Groups set up by the Planning Commission.
LOCAL RECRUITMENT
—
“
In earlier schemes, a Balsevika with a
matriculate qualification and 11 months' training was recruited,
and was usually an outsider.
In its efforts to keep ICDS community
based, the educational qualifications and the period of training were
reduced so as to encourage recruitment of local young women.
Further,
in order to avoid creating a rural bureaucracy with a fixed salary
structure (based on governmental rules and regulations), the local
field worker is recruited as an honorary worker of the ccmnunity.
TRAINING —
Training programmes have been designed for every level
of fvncti onary-
The training for CDPOs and supervisors emphasizes
administrative and managerial skills.
Anganwadi workers, in keeping
with their limited educational background (mostly primary school level),
are given substantive training in the areas of child development at
locally-run institutions
supervised by State Governments and non
governmental organisations.
Trainers/instructors, drawn from established academic institutions
also receive special orientation programmes to acquaint them, with the
areas covered by ICDS.
The involvement of academic institutions and
departments of medicine has enriched the quality
of training and
50
further strengthened the caimitment of members of the medical profession
to community-based child development progrartme^.
Inservice draining is necessary to develop an efficient cadre
of child development workers.
Refresher courses for supervisors and
CDPOs are organised regularly.
Anganwadi workers receive periodic
re-orientation to update their knowledge and equip them with skills
to combat specific
problems like infant mortality and morbidity.
Currently, nw approaches are under investigation
to use mass media
for ccmnunity education using the ICDS structure as the focal point.
INVOLVEMENT OF ACADEMIC INSTITUTIONS —
Academic institutions were
involved in this scheme from the beginning.
At the national level the
All India Institute of Medical Science expertise monitor and
evaluate the health components of the scheme.
At the field level,
medical consultants and colleges monitor the progress of specific
projects and training of personnel.
Heme Science colleges and
Agricultural Universities are involved in training field level workers.
MONITORING AND EVALUATION
—
Accordingly, a baseline survey and
a
repeat survey have been conducted by the Programme Evaluation Organi sa-t-inn
of the Planning Commission.
Continuous npnitoring and evaluation of the
health and nutrition components is done by the MIMS.
The present assessment is based on a review of randomly sol acted
projects initiated in 1978-79.
A comparison with the findings of
earlier reviews done by the Planning Certmission indicate seme positive
changes in the five years which separate the two reviews.
One such area is in coverage of the vulnerable 0-3 age group.
The PEO repeat survey, based on 1976-78 data, indicated that 35 cer r^n+-
of the children in the age group 0-3 were covered.
The present study
51
shows a coverage of 50%
of 60%
for the 0-6 group as a whole.
as ma 1 nourished.
women
for this age group and an over-all coverage
Of these, 4.5% are identified
Estimates of attendance by pregnant and 1 actati ng
are not very reliable although there are clear indinationr
that the services only reach the very poor.
There is a need to work
out the physical targets more accurately at the State level analysing
the age composition of the block in order to reach this group and
to plan financial inputs more realistically.
HEALTH COVERAGE
—
Health coverage generally, and immunization in
particular have inproved.
Before the launching of ICDS, immunization
coverage was under 20 per cent in sone blocks, in others less than
10 per cent.
The present coverage has gone beyond
50 per cent but
there is a high drop out rate in vaccinations administered in a
series.
In tribal and rural blocks vaccines are not available, the
visits of the para-medical and medical staff are irregular.
Arrangements for referral services in seme of the blocks are not
made
because the workers are not aware of this component and do not know
how to make necessary arrangements.
The study also found that some
of the important drugs are not generally available
sppriany in rural and tribal blocks.
when needed
In these blocks it was observed
that the visits of the medical and para-medical staff were irregular
as most of the time they were busy with family planning and other
campaigns.
Even though severely malnourished children were detected
by doctors,
there has been no special diet developed for them.
usual food supplement is merely doubled.
The
Some of the medical staff
suggested that a budget for medicines should be placed
at the
disposal of the CDPO to make local purchases since Medical officers had no
yreans to purchase medicines.
PRE-SCHOOL COMPONENT —
The non-formal education component of ICDS
functions reasonably well in sane areas but is decidedly weak in others.
A-0 0
COMiv/JX;'!' / ’'
*
47/1. (Fittt
r..
■. C,
'*
"J
F<a<3|
52
Tests administered to children show a normal level of cognitive
development.
The observed personal hygiene and appearance of the
children, however, is generally poor.
weakness,
This is linked with another
namely, the health and nutrition education component.
Responses from mothers indicate that although they are aware that
health care and inmunization are generally "good" , they do not
make the yi tai connection between malnutrition and disease which
diminishes the preventive impact of the programme.
COMMUNITY PARTICIPATION
is rather poor.
—
Community contribution and participation
Local participation in developmental programmes has
always been low as indicated in evaluations of previous schemes.
Ad hoc
assistance takes the form of land and buildings, offered by the
Panchayats:
grain, firewood, or labour offered by families; and help
from mothers to the anganwadi workers.
The programme is likely to have
only limited success unless systematic efforts are made to involve
Panchayat Ra.j Institutions, local communities and beneficiary families
in an organised manner.
The quality and applicability of training
administered to various functionaries, the magnitude of community
involvement, the regularity of the delivery of supplementary food,
the social and cultural barriers which limit participation by certain
castes of beneficiaries, the weak link between the grassroot-level worker
and the block-level administration, are a few of the questions raised,
to which no conclusive
answer can be given in the limited scope of
this study.
ATTITUDINAL CHANGE
Although there is a decided change in attitudes at the vi 11 age
level, it is not possible to attribute this solely to the scheme.
The discrepancy between the records of births and deaths kept at the
COMMUNITY HEALTH CELt>
3?6. V Mein. I Block
Koiarrungala
Bangalore-560034
53
India
Anganwadi, the records of the Panchayat and govemnent figures
based on national averages, make it difficult to generalize on
questions of morbidity and mortality at this stage.
Is ICDS cost-effective?
The study (Chapter V) outlines the
cost of the scheme based on recurring expenditure per project, ccmparing
ICDS with the project cost of other feeding programmes like SNP,
ANP and TNP.
Despite a wider range of services and larger coverage,
it concludes that ICDS is less expensive.
Using 1982 estimates, the
estimated operating cost for 1000 ICDS projects is 0.66% of the
GDP of India.
It concludes that there is scope both to extend the
coverage of the scheme, as well as allocate more resources to
existing projects.
Annexure
1
DEMOGRAPHIC DATA
NUMBER OF CHILDREN IN THE AGE GROUP OF 0-3 ENROLLED IN FEEDING PROGRAMME
Type
of
Project
Total
Children in the
No. of children S.C. Children
S.T.children Other enrolled for
popula- age group 0-3
enrolled for
enrolled for
enrolled for
feeding
tion
feeding
feeding
feeding
Total %age to
Number %age to
Number %age to Number %age to Number %age to
the total
the tot.
the tot .
the total
the total
population
children
enrolment
enrolment
enrolment
RURAL
103167
6123
5.9
2347
38.3
738
31.4
162
6.9
1447
61.7
TRIBAL
37281
2495
6.7
1618
64.8
238
14.7
1069
66.1
311
19.2
URBAN
24947
3099
12.4
1360
43.9
624
45.9
244
17.9
492
36.2
5325
45.4
1600
30.0
1475
27.7
2250
42.2
TOTAL
165395 11717
tn
Annexure - 2
DEMOGRAPHIC DATA
NUMBER OF CHILDREN IN THE AGE GROUP 3-6 ENROLLED IN FEEDING PROGRAMME
Type
of
project
No .of
projects
Tot.
population
Children in the No.of children
S.C. children
age group 3-6
enrolled for
enrolled for
feeding
feeding
Total %age to
Number %age to Number %age to
the tot.
the tot.
the tot.
population
children
enrolment
S.T.children Others enrolled
enrolled for
for feeding
feeding
Number %age to No. %age to
the tot
the tot.
enrolment
enrolled
RURAL
6
103167
7671
7.4
3065
39.9
951
31.0
320
10.4
1794
58.5
TRIBAL
4
37281
2950
7.9
1825
70.4
207
11.3
1162
63.7
456
25.5
URBAN
3
24947
2107
8.4
1228
58.3
378
30.8
215
17.5
635
51.7
TOTAL
13
165395
12728
6118
48.1
1536
25.1
1695
27.7
2885
47.1
cn
cn
Annexure
3
NUMBER OF CHILDREN ATTENDING ANGANWADIS
Type of
anganwadi
No. of boys
Tot.No. of No.of children
children in attending angan- attending
anganwadi_____
the age
wadi 0-6_______
Number %age to
group 0-6 Number %age to
the tot
the tot.
attending
attending
No. of girls
attending
anganwadi______
Number Sage to
the tot.
attending-
No. of children identified
as severely malnourished
Boys
Girls
Total No.
of children
with malnutri
tion
RURAL
13794
5412
39.2
2955
54.6
2457
45.4
125
111
236
TRIBAL
5445
3443
63.2
1728
50.2
1715
49.8
54
62
116
URBAN
5206
2558
49.7
1363
52.7
1225
47.3
65
85
150
TOTAL
24445
11443
46.8
6046
52.8
5397
47.2
244
258
502
Ln
cn
Annexure
4
ENROLMENT AND ATTENDANCE OF PREGNANT WOMEN
Number of Pregnant Women Enrolled of which
Type of Centre
Total
Scheduled Caste
Numbers
Percentage
Scheduled Tribe
Numbers
Percentage
Others
Numbers Percentage
RURAL
1149
318
27.6
300
26.1
531
46.2
TRIBAL
348
46
13.2
224
64.4
78
22.4
URBAN
478
102
21.3
129
26.9
247
51.6
TOTAL
1975
466
23.6
653
33.0
856
43.3
Annexure
5
PROVISION OF FOOD AT THE CENTRE
Type of
Centre
Type of food given at the
Use of local vege
Number of days
Centre
tables, fresh vegetables
Less than
Cooked at Ready-to-■ Others
Used
Not
250 days
150 to 250
or above
anganwadi
eat
Used
days
150 days
RURAL
17
21
12
13
40
38
7
8
TRIBAL
33
2
10
8
37
33
12
0
URBAN
14
11
11
9
17
20
6
0
TOTAL
64
37
23
30
94
91
25
8
Ln
oo
Annexure - 6
Total number of children enrolled for feeding and the percentage in the age group 0-3
Type of village
Total number of
children in the
age group 0-6
Total number of
children enrolled
for feeding
Total number of
children en
rolled for feed
ing in the age
group 0-3
RURAL
13,794
5,412
2,347
43.36
TRIBAL
5,445
3,443
1,618
46.99
URBAN
5,206
2,588
1,360
52.5
TOTAL
24,445
11,443
5,325
46.53
Percentage of
children in
the age group
0-3 in the
total numbers
enrolled for
feeding
Annexure - 7
Children in the Age Group 0-3 and
3-6 - Numbers enrolled for feeding
Type of
village
Children in the age group 0-3
No.of children ?%age of children
enrolled for
belonging to S.C.
feeding in the
in age group en
age group 0-3
rolled for feed
ing 0-3
1
1
%age of children belonging
to S.T. in the
age'group enrolled for
feeding 0-3
RURAL
2,347
31.4
6.9
TRIBAL
1,618
14.7
66.1
URBAN
1,360
45.9
17.1
TOTAL
5,325
30.0
27.7
Children
j No.of
i children
[ enrolled
j for feed
> ing in the
j:age group
ii
3"6
i
i1
1;
1I
1
1l
| 3,065
1
1
1
! 1,825
1
1
1
1 1,228
1
1
1
i 6,118
in the Age group 3-6
Sage of
%age of
children
children
belonging belonging to
to S.C. in S.T. in the
the age
age group
group 3-6
3-6
31.0
10.4
11.3
63.7
30.8
17.5
25.1
27.7
i
i
i
Ch
o
Annexure
8
BIRTH AND DEATH RATES REPORTED AT CENTRES SURVEYED
1.
2.
Rural
Tribal
48
37
18
92437
30657
17275
1390
477
430
Urban
BIRTH RATES
a)
Total number of villages/centres reporting
b)
Total population of villages/centres reporting
c)
Total number of births
d)
Average number of births per village
28.95
12.89
23.89
e)
Birth rate
15.03
15.56
24.89
92437
30657
17275
42
37
18
314
139
42
DEATH RATES
a)
Total population of villages reporting
b)
Number of villages reporting
c)
Total number of deaths
d)
Average number of deaths per village
7.47
3.76
2.33
e)
Death rate
3.40
4.53
2.43
3
Annexure
IMMUNIZATION COVERAGE
No. of villages reporting
41
41
18
1.
Polio
a)
Number of doses
1st dose
2nd dose
3rd dose
2013
1357
935
1887
1615
1062
669
534
466
Average
1st dose
2nd dose
3rd dose
49.09
33.09
22.80
46.02
39.39
25.90
37.17
29.67
25.89
b)
2.
B.C.G.
a)
b)
No. of doses
Average
1280
31.22
810
19.75
780
43.33
3.
a)
b)
D.P.T.
No. of doses
Average
2026
49.41
868
21.17
679
*
37.72
4.
Vitamin A
a)
b)
No. of doses
Average
1251
30.51
1588
38.73
1210
67.22
*
Break-up of information on three doses not yet available
9
Annexure
IMMUNIZATION COVERAGE
18
No. of villages reporting
1.
Polio
a)
Number of doses
1st dose
2nd dose
3rd dose
2013
1357
935
1887
1615
1062
669
534
466
Average
1st dose
2nd dose
3rd dose
49.09
33.09
22.80
46.02
39.39
25.90
37.17
29.67
25.89
b)
2.
B.C.G.
a)
b)
No. of doses
Average
1280
31.22
810
19.75
780
43.33
3.
a)
b)
D.P.T.
No. of doses
Average
2026
49.41
868
21.17
679
*
37.72
4.
Vitamin A
a)
b)
No. of doses
Average
1251
30.51
1588
38.73
1210
67.22
*
Break-up of information on three doses not
yet available
to
Annexure - 10
ATTENDANCE IN FLAW CLASSES
Rural
Tribal
Urban
a)
Number of villages reporting operation
40
29
18
b)
Number of villages reporting no
operation
13
16
8
c)
Total enrolled in 1982
1431
607
305
d)
Average enrolment
35.77
20.93
16.9
e)
Total attendance in July 1982
855
339
264
f)
Average attendance in July 1982
21.37
11.69
14.67
g)
Total attendance in November 1982
908
330
265
h)
Average attendance in November 1982
22.7
11.37
14.72
Annexure -11
OBSERVATION OF THE RESEARCH TEAM AT THE ANGANWADI
Type of
Anganwadi
Clean
surroundings
Not clean
Toilet Facility
No. of anganwadi No. of anganwadis
without toilet
with toilet
RURAL
33
20
52
1
TRIBAL
29
16
43
2
URBAN
18
8
10
16
TOTAL
80
44
105
19
Annexure - 12
OBSERVATION OF RESEARCH TEAM ON THE PERSONAL HYGIENE OF CHILDREN
1
1
Type of J
Angan- 1[
I For
wadi
‘ all
i
i
i
i
i
1
H Y G I E N E
PER SON.A L
1
Dress
] Cleanliness of- Dress i
Combing
Nails cut
Most Some Few j All Most Some Few
jAll Most Some Few
For
For
For I All
most some few i fully fully fully fully i wore wore wore wore jwell well well well
j clad clad clad clad }clean clean clean clean com--com comb comb
i
ed
ed
]dress dress dress dres^ bed bed
i
i
i
i
RURAL
0
19
20
14
10
20
17
6
4
9
16
24
3
16
18
16
TRIBAL
5
13
16
11
2
19
12
12
1
11
16
17
0
11
21
13
URBAN
4
15
5
2
4
14
7
1
2
12
11
1
6
12
8
0
TOTAL
9
47
41
27
16
53
36
19
7
32
43
42
9
39
47
29
Ln
Annexure
13
ASSESSMENT OF COMPREHENSION AND COGNITIVE DEVELOPMENT
Type of 1 All of|
angan[ them
■
wadi
ii iden- i
ii tify
I
i
i
XU
!'
10
i
i
1
Identification of pictures
Most ot[ Some ofj Few ofr None or |
them i them i
them
i them
iden- ) iden- | iden- J idenJ
tify
J tify
[ tify ' tify
7-9
i 4-6
i 1-3 ■ i 0
I
Story telling, recitation, etc.
)
All of tnem jMost ot some or few or None or
do so
i them
i them i them i
them
[ do so | do so j do so J do so
i
i
i
1
4-6 i 1-3
i
10
0
i
RURAL
4
24
9
14
2
6
22
6
10
9
TRIBAL
1
25
8
7
4
1
23
14
7
0
URBAN
0
14
8
4
0
4
11
9
2
0
TOTAL
5
63
25
25
6
11
56
29
19
9
TOTAL
£ 3
0) y
H- 3
3
I O
Hl
Numbers
contributed
Nos. did not
contribute
i
Financial
Land
Equipment
Food
Commodities
Firewood
Any other
Numbers
contributed
Nos. did not
contribute
Financial
ASSESSMENT OF COMMUNITY PARTICIPATION
Building
Land
Building
Equipment
Food
Commodities
Firewood
a
s
(0
X
3
(D
Labour
Any other
Z.9
Annexure
15
ASSESSMENT OF COMMUNITY PARTICIPATION
Type of
anganwadi
Contribution by
Individual/
Philanthropists
Nos.con- Nos.did not
tributed contribute
Nature of contribution by individual/
Philanthropists(No.)
Contributed by
voluntary agencies
Finan- Land
cial
Build- Equip- Food Fire Any
ing
ment commo wood Other
dities
Nos.contributed
RURAL
7
46
0
1
1
0
2
4
2
0
TRIBAL
7
38
1
0
1
0
0
4
1
0
URBAN
0
26
0
0
0
0
0
0
0
0
TOTAL
14
110
1
1
2
0
2
8
3
0
CTl
05
Annexure
16
CO-ORDINATION COMMITTEES AT VILLAGE LEVEL
Type of
Village
[ Committee set
i up in village
no
i Yes
i
i
i
COM
;
i|
i
School
teacher
0
P
S
T
ION
Pancha- Pancha- Village Mahila
yat pre yat
Elders Mandal
sident
Member
Ladies
Local
Women
]
|i
I
Social Pastor AnganWorkers
wadi
worker
RURAL
24
29
13
13
14
15
2
8
2
0
24
TRIBAL
20
25
10
16
11
13
2
8
0
3
20
URBAN
13
13
7
0
0
0
9
5
5
0
13
TOTAL
57
67
30
29
25
28
13
21
7
3
57
17
Annexure
FUNCTIONING OF THE VILLAGE LEVEL COMMITTEE
Type of
village
!
NO. Of times the»
i
committee met in a year
i
i
j Once
Twice Thrice Four
i
to 6
i
times
i
| Records
i Maintained
i
i
More [ Yes
No
than i
6 timeb
| Follow-up
i mechanism
i
i
j Yes
No
i
i
i
|
i
i
i
]
1
1
1
Decisions in meetings
executed
Early
Delayed Not
executed
RURAL
4
2
1
10
7
21
3
20
1
21
3
0
TRIBAL
0
4
0
3
13
12
8
7
5
14
3
3
URBAN
0
0
0
1
12
12
1
6
6
7
6
0
TOTAL
4
6
1
14
32
45
12
33
12
42
12
3
o
Annexure
18
OPINION OF BENEFICIARIES ON ICDS AND ITS FUNCTIONING
NUMBER OF CHILDREN
2 &
3-5
5 &
ABOVE
LESS
FAMILY PLANNING
NOT
IN FA NOT IN
VOUR
FAVOUR AWARE
OPINION ON THE SIZE OF FAMILY
2
1
3
4 OR
CHILD CHILDREN CHILDREN MORE
RURAL
36
0
0
74
4
0
54
1
2
231
18
8
34
3
1
11
0
0
1
0
0
53
6
2
148
12
4
29
0
2
41
2
0
55
2
3
47
2
4
95
5
11
99
4
6
28
8
3
2
0
0
23
2
4
40
3
6 .
30
0
1
BENEFICIARY FAMILY
PANCHAYAT MEMBERS
PANCHAYAT PRESIDENT
15
0
0
’28
0
0
29
0
0
84
0
0
32
0
0
0
0
0
2
0
0
28
0
0
52
0
0
2
0
0
TOTAL
BENEFICIARY FAMILY
PANCHAYAT MEMBERS
PANCHAYAT PRESIDENT
92
2
0
157
6
3
130
3
6
410
23
19
165
7
7
39
8
3
5
0
0
104
8
6
240
15
10
61
0
3
94
166
139
452
179
50
5
118
265
64
BENEFICIARY FAMILY
PANCHAYAT MEMBERS
PANCHAYAT PRESIDENT
TRIBAL
BENEFICIARY FAMILY
PANCHAYAT MEMBERS
PANCHAYAT PRESIDENT
URBAN
TOTAL
Annexure - 19
OPINION OF BENEFICIARIES ON ICDS AND ITS FUNCTIONING
KNOWLEDGE OF ICDS
IMMUNIZA- HEALTH CHECK
TION
UP
Aware Not Aware NOt
Aware
Aware
VITAMIN A
DISTRIBUTION
PRESCHOOL
EDUCATION
SUPPLEMENTARY
NUTRITION
Aware Not
Aware
Aware
Not Aware Not Aware
Aware
Aware
Not
Aware
FLAW
RURAL
BENEFICIARY FAMILY
PANCHAYAT MEMBERS
PANCHAYAT PRESIDENT
276
20
9
0
1
0
242
15
9
34
5
0
228
15
5
48
5
4
269
21
9
4
0
0
256
20
9
20
0
0
236
16
9
40
4
0
222
17
20
0
0
0
177
9
17
45
8
3
208
17
20
14
0
0
221
17
20
0
0
0
211
17
19
11
0
1
207
15
19
15
2
1
115
0
0
1
0
0
85
0
0
30
0
0
114
0
0
1
0
0
117
0
0
1
0
0
115
0
0
0
0
0
96
0
0
19
0
0
613
37
29
1
1
0
504
24
26
109
13
3
550
32
25
63
5
4
607
38
29
5
0
0
582
37
28
31
0
1
539
31
28
74
6
1
679
2
554
125
607
72
674
5
652
32
598
81
TRIBAL
BENEFICIARY FAMILY
PANCHAYAT MEMBERS
PANCHAYAT PRESIDENT
URBAN
BENEFICIARY FAMILY
PANCHAYAT MEMBERS
PANCHAYAT PRESIDENT
TOTAL
BENEFICIARY FAMILY
PANCHAYAT MEMBERS
PANCHAYAT PRESIDENT
TOTAL
Annexure
20
OPINION OF BENEFICIARIES ON ICDS AND ITS FUNCTIONING
FEEL IMMUNIZATION IS
Good
Not Good
Prevents
Diseases
IMMUNIZATION
Help growth
of child
Others
RURAL
BENEFICIARY FAMILY
235
7
196
20
19
PANCHAYAT MEMBERS
15
0
15
1
2
PANCHAYAT PRESIDENT
9
0
7
0
2
BENEFICIARY FAMILY
176
1
162
12
4
PANCHAYAT MEMBERS
9
0
6
3
0
PANCHAYAT PRESIDENT
17
0
14
4
0
BENEFICIARY FAMILY
83
2
73
14
0
PANCHAYAT MEMBERS
0
0
0
0
0
PANCHAYAT PRESIDENT
0
0
0
0
0
BENEFICIARY FAMILY
494
10
431
46
23
PANCHAYAT MEMBERS
24
0
21
4
2
PANCHAYAT PRESIDENT
26
0
21
4
2
G-TOTAL
544
10
473
54
27
TRIBAL
URBAN
TOTAL
Annexure
21
VITAMIN A AND IRON AND FOLIC ACID
DISTRIBUTION AND SUPPLEMENTARY NUTRITION
OPINION OF BENEFICIARIES ON ICDS AND ITS FUNCTIONING
PRG. INCLUDES IF YES PROGRAMME _______ PRG.
VITAMIN & IRONF HELPS HELPS PRE OTHERS
DISTRIBUTION
PRE GROWTH VENTS
INCLU
VENT
DISEA
DES SUPP.
BLIND
SES
NUT.RN.
NESS
Yes
No
Yas
_ No___
IF YES PROGRAMME
HELPS PRE
OTHERS
GROW VENTS
TH
DIS
EASES
RURAL
BENEFICIARY FAMILY
PANCHAYAT MEMBERS
PANCHAYAT PRESIDENT
149
10
4
87
6
5
62
5
1
29
0
0
38
2
3
19
3
0
268
21
8
1
0
1
155
0
4
20
1
0
88 '
11
4
118
. 7
15
89
8
4
45
2
3
30
2
9
40
3
3
2
0
0
221
17
20
0
0
0
166
14
16
. 32
3
2
21
0
2
78
0
0
18
0
0
24
0
0
32
0
0
20
0
0
2
0
0
116
0
0
1
0
0
83
0
0
27
0
0
4
0
0
345
17
19
194
14
9
131
7
4
91
2
9
98
5
6
23
3
0
605
38
28
2
0
1
404
23
20
79
4
2
113
11
6
381
217
142
102
109
26
671
3
447
85
130
TRIBAL
BENEFICIARY FAMILY
PANCHAYAT MEMBERS
PANCHAYAT PRESIDENT
URBAN
BENEFICIARY FAMILY
PANCHAYAT MEMBERS
PANCHAYAT PRESIDENT
TOTAL
BENEFICIARY FAMILY
PANCHAYAT MEMBERS
PANCHAYAT PRESIDENT
G-TOTAL
Annexure -22
PRE-SCHOOL EDUCATION AND FLAW
OPINION OF BENEFICIARIES ON ICDS AND ITS FUNCTIONING
IF YES PROGRAMME PROGRAMME
HELPS HELPS OTHERS INCLUDES
MENTAL EDUCA
FLAW
GROWTH TION
Yes
No
PROGRAMME
INCLUDES PRE
SCHOOL
EDUCATION
. Yes
No
IF YES PROGRAMME
HELPS OTHERS
HELPS FLAW
LEARN HELPS ACQUIRE
OBTAIN KNOW
ING
SKILLS LEDGE
RURAL
BENEFICIARY FAMILY
PANCHAYAT MEMBERS
PANCHAYAT PRESIDENT
256
21
6
7
0
1
40
4
1
188
11
4
26
6
1
148
11
3
108
10
4
71
1
0
29
2
0
30
5
1
21
3
2
216
17
20
2
0
0
57
4
8
■152
13
12
4
0
0
113
12
6
98
5
13
52
3
2
35
2
23
1
4
3
0
0
112
0
0
5
0
0
43
0
0 '
71
0
0
0
0
0
94
0
0
27
0
0
33
0
0
30
0
0
30
0
0
2
0
0
584
38
26
14
0
1
140
8
9
411
24
16
30
6
1
355
23
9
233
15
17
156
4
2
94
9
2
83
6
5
26
3
2
648
15
157
451
37
387
265
162
105
94
31
TRIBAL
BENEFICIARY FAMILY
PANCHAYAT MEMBERS
PANCHAYAT PRESIDENT
7
URBAN
BENEFICIARY FAMILY
PANCHAYAT MEMBERS
PANCHAYAT PRESIDENT
TOTAL
BENEFICIARY FAMILY
PANCHAYAT MEMBERS
PANCHAYAT PRESIDENT
G. TOTAL
.
Annexure
23
OPINION OF BENEFICIARIES ON ICDS AND ITS FUNCTIONING - COMMUNITY PARTICIPATION
BENEFICIARY WOULD
LIKE TO HELP THE PROGRAMME
No
Yes
HELP THE PROGRAMME THROUGH CONTRIBU
TION OF
Firewood Vegetables Labour
Grains
RURAL
• 150
15
7
115
4
2
45
9
4
113
13
6
11
2
2
106
11
2
113
13
9
107
4
11
13
0
0
75
9
7
7
0
1
70
13
6
75
0
0
46
0
0
28
0
0
8
0
0
24
0
0
68
0
0
BENEFICIARY FAMILY
PANCHAYAT MEMBERS
PANCHAYAT PRESIDENT
338
28
16
268
8
13
86
9
4
196
22
13
42
2
3
244
24
8
G. TOTAL
382
289
99
231
47
276
BENEFICIARY FAMILY
PANCHAYAT MEMBERS
PANCHAYAT PRESIDENT
TRIBAL
BENEFICIARY FAMILY
PANCHAYAT MEMBERS
PANCHAYAT PRESIDENT
URBAN
BENEFICIARY FAMILY
PANCHAYAT MEMBERS
PANCHAYAT PRESIDENT
TOTAL
cn
___
Annexure
24
OPINION OF BENEFICIARIES ON ICDS AND ITS FUNCTIONING: HEALTH STATUS
CHILD FELL ILL
DURING LAST
15 DAYS
Yes
No
YES
IF
1 day
TYPE OF SICKNESS
2 days
3-5
days
More
than
5 days
Fever
Diarrhoea Respira
tory Ail
ments
RURAL
BENEFICIARY FAMILY
PANCHAYAT MEMBERS
PANCHAYAT PRESIDENT
97
3
0
178
11
6
14
0
0
18
1
0
32
0
0
35
2
0
204
11
2
148
4
1
116
8
2
70
2
2
149
10
12
17
0
0
20
2
1
18
0
0
18
0
1
140
4
9
84
2
5
104
3
6
34
0
0
87
0
0
7
0
0
8
0
0
8
0
0
11
0
0
79
0
0
63
0
0
95
0
0
201
5
2
414
21
12
38
0
0
46
3
1
58
0
0
64
2
1
423
15
9
295
6
5
375
11
6
208
447
38
50
58
67
447
306
392
TRIBAL
BENEFICIARY FAMILY
PANCHAYAT MEMBERS
PANCHAYAT PRESIDENT
URBAN
BENEFICIARY FAMILY
PANCHAYAT MEMBERS
PANCHAYAT PRESIDENT
TOTAL
BENEFICIARY FAMILY
PANCHAYAT MEMBERS
PANCHAYAT PRESIDENT
G.TOTAL
Annexure
25
OPINION OF BENEFICIARIES ON ICDS AND ITS FUNCTIONING
IF YES, THAN THE TYPE AND INCIDENCE OF ILLNESS
Child fell__
RESPIRATORY AILMENTS
ill during
DIARRHOEA
FEVERS
the last --More
On- TwTh
On Tw
Th
More
More
one year On Tw Th
than 3
ee ice
rice
ce ice rice than 3
ce ice rice than 3
times
times
times
RURAL
57
2
0
56
4
0
31
2
0
61
3
2
40
2
0
46
0
0
34
2
0
29
0
1
27
2
0
51
0
0
42
2
1
58
4
1
66
4
6
35
0
3
25
0
0
20
0
0
25
0
3
34
1
1
15
0
1
13
1
0
34
2
5
32
0
1
20
0
0
21
1
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
516
BENEFICARY FAMILY
16
PANCHAYAT MEMBERS
PANCHAYAT PRESIDENT 12
139
6
6
123
4
3
75
2
0
93
3
2
80
2
3
91
1
1
65
2
1
62
1
1
73
4
5
117
0
1
94
2
1
96
5
1
544
151
130
77
98
85
93
68
64
82
118
97
102
BENEFICIARY FAMILY 240
11
PANCHAYAT MEMBERS
2
PANCHAYAT PRESIDENT
TRIBAL
BENEFICIARY FAMILY 169
5
PANCHAYAT MEMBERS
PANCHAYAT PRESIDENT 10
URBAN
PANCHAYAT MEMBERS
PANCHAYAT PRESIDENT
TOTAL
G. TOTAL
oo
79
Primary Source
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2^ IFDS
Krishnamurty, March 1983.
2.
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3.
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An analysis of the situation of children in India.
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4.
Sample Registration System - 1978.
specific death rates.
Infant mortality rates and age
Volume 13, No.2, December 1979.
5.
Causes of Death
- (1978).
Vital Statistics Division, Registrar General of India, Ministry of
Herne Affairs, Government of India, New Delhi.
6.
Tandon B.N., Ramachander K. and Bhatnagar S. Integrated Child
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(1981). Objectives, organisation
and baseline survey of the project population.
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7.
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8.
Recommended Dietary Intakes for Indians
(1981).
Indian Council of Medical Research, New Delhi.
9.
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(1974).
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10.
lyenger A.K.
(1980)
in 'Studies in protein metabolism'.
Ph.D thesis, University of Banbay.
11.
annual Report of the National Nutrition Monitoring Bureau
(1976)
National Institute of Nutrition, Hyderabad.
12
Report of the National Nutrition Monitoring Bureau for 1978 (1979).
National Institute of Nutrition, Hyderabad.
80
13.
Report of the Committee on pre-school children feeding programme
(1972).
Planning Canmission, Government of India, New Delhi.
14.
Evaluation of the Applied Nutrition Programme
(1978).
National institute of Rural Development, Hyderabad.
15.
The Integrated Child Development Services Scheme (Revised) - (1982).
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16.
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(1978).
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17.
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India, New Delhi.
18.
Chikkara Sudha, (1982)
in ' Infant and Maternal Morbidity and Mortality in one ICDS block of
Haryana State'.
M.Sc thesis, Haryana Agricultural University, Hissar, Haryana.
19.
Phogat Sudha, (1982)
in Evaluation of the impact of the ICDS on the beneficiaries in a
selected block of Haryana State'.
M.Sc thesis, Haryana Agricultural University, Hiswar, Haryana.
20.
Tandon B.N. et al (1981).
A co-ordinated approach to children's health in India - The Integrated
Child Development Services.
Lancet, 1_, 650.
21.
Knudsen K.
(1981).
The Economics of Supplemental Feeding of Malnourished Children.
World Bank Staff Working Paper No.451.
22.
The Sixth Five Year Plan 1980-85
(1981).
Planning Carmission, Government of India, New Delhi.
23.
Sahn, 'The Integrated Maternal and Child Nutrition Project - India'
Reccrrmendations based on a review of past experiences
a '
USAID 1980, P 115.
/...
81
Secondary Source
1.
Swany V.S.
(1980).
'Seme aspects of child mortality - A profile'
Paper presented at the Fifth Annual Conference of the Indian Assnci a-H on
for the study of 'Population Dynamics and Rural Development'
Indian Institute of Technology, Banbay.
2.
Puffer R.R. and Gerrano C.V.
(1973)
Pan American Health Organisation Scientific Publication No. 262.
3.
Gopalan C. and Narasinga Rao B.S.
(1971).
Proceedings of the Nutrition Society of India, Volume 10, 111.
4.
Srikantia S.G.
(1973).
Scientific basis for supplementary feeding progranmes for pre-school
children.
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5.
Narasinga Rao B.S., Visweswara Rao K. and Nadarauni Naidu A.
(1968).
Tndian Journal of Nutrition and Dietetics, Volume 6, 238
6.
Saranayaki M.
(1982).
A study of the functioning of the Anganwadis in the ICDS scheme in
Tamil Nadu.
Avinashalingam Chettiar Hone Science College, Coimbatore, Tamil Nadu.
7.
Gupta A.K. and Khosa A.
(1982).
(unpublished results).
The Integrated Child Development Services Scheme - An appraisal.
Model Institute of Education and Research, Jammu, Jairtnu and Kashmir.
8.
Gopalan C. and Vijayaraghavan K.
Nutrition Atlas of India.
(1971).
National Institute of Nutrition, Hyderabad.
9.
Project Poshak.
(1975)
An Integrated Health-Nutrition Macro pilot study for pre-school children
in rural and tribal Madhya Pradesh.
CARE (India).
10.
Wyon JGordon J.
in 'The Khanna Study'.
(1971).
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11.
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Morbidity and Mortality Effects.
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82
12.
Proceedings of the-National Conference pn Evaluation of PrimaryHealth Care Programmes.
(1980).
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13.
Proceedings of the National Seminar on Special Nutrition Programme.
(1978).
National Institute for Public Co-operation and Child Development,
New Delhi.
INTEGRATED CHILD DEVELOPMENT SERVICES
AN ASSESSMENT
UNICEF
REGIONAL OFFICE FOR SOUTH CENTRAL ASIA
73 LODI ESTATE
NEW DELHI-110003
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