Flagships adrift

In Anantapur, Andhra Pradesh, a protest by anganwadi workers at the ICDS office in January 2010.-R.V.S. PRASAD

The ICDS' plight is symptomatic of the problems plaguing the Union government's flagship schemes for the poor all over the country.

INDIA may be the only country in the world where we describe the ensuring of the basic socio-economic rights of the people in terms of flagship schemes that are seen as the benevolent contribution of governments. One problem with this approach is that the delivery of basic services is not seen as part of the general institutionalised and accountable functions of the state, but rather in terms of schemes whose norms can flout basic norms (certainly de facto if not de jure) and yet be seen as positive new interventions. They can also simultaneously be questioned by those who tend to oppose any public delivery, by attacking such schemes as being populist and electorally motivated, simply because they are not recognised as essential functions of government.

This is certainly true of a very wide range of the schemes defined by the United Progressive Alliance (UPA) government, ranging from education (the Sarva Shiksha Abhiyan or SSA) to health (the National Rural Health Mission or NRHM) to employment (the Mahatma Gandhi National Rural Employment Guarantee Act or MGNREGA). All this may be part of the process of transition from zero or poor delivery of basic public services to the eventual goal of complete delivery, and some of the concerns with the schemes mentioned here may be described as teething problems that will get sorted out with experience.

However, lack of experience cannot be an excuse for one of the Integrated Child Development Services (ICDS), which was launched in 1975 and, therefore, has functioned in the country for nearly four decades. It is the world's largest early child development programme, the purpose of which is to provide an integrated package of service to children aged from 0 to 6 years, expectant and nursing mothers and women of childbearing age. The services include supplementary nutrition, immunisation, health check-up, medical referral services, nutrition and health education and pre-school education.

The goals of the ICDS are ambitious: to improve nutritional and health status of children and mothers; to lay the foundation for the proper development of children; to reduce the incidence of mortality, morbidity, malnutrition and school drop-outs; to create convergence and co-ordination of policy and implementation among various departments to promote child development; to enhance the capability of mothers to look after children through nutrition and health education.

The ICDS involves the setting up of anganwadi centres, each of which is intended to cater to a population of around 1,000 in rural and urban areas and around 700 in tribal areas. The coverage of the scheme has expanded since 2005, although it is still not universal despite repeated instructions by the Supreme Court. Further, the formidable list of services required are supposed to be delivered by only one anganwadi worker and one helper per centre, who still (despite recent increases) do not receive even minimum wages but only a pitiful honorarium.

Obviously, the still poor indicators of women's and children's health throughout much of the country suggest that the flagship has not met expectations. Some of this can be attributed to the niggardly resources that have been provided for it, especially the continued attempt to provide these basic services through underpaid women's labour. But quantitative measures are not enough in judging the efficacy of the scheme. This is what makes the role of social audits especially important.

A recent social audit of the ICDS in Andhra Pradesh provides detailed and extremely important insights into the functioning of the scheme. The results have been summarised in a new book ( The Integrated Child Development Services: A flagship adrift by K.R. Venugopal, New Delhi: Konark Publishers 2012) that should be read by all those concerned not just with this programme but with the basic conditions of human development in the country.

The social audit was conducted in Andhra Pradesh the largest district of the country, similar to many small countries. (Just for comparison, at more than 19 square kilometres, Anantapur is around the size of Israel, and with more than 4 million residents, its population is close to that of Ireland.) It is also relatively poor and the rural population has been beset by continuing agrarian crisis. The social audit covered a wide range of issues: immunisation; health check-ups and referral; the efficacy of supplementary nutrition and the form it takes (locally cooked or prepared ready-to-eat; other roles such as pres-school education and maternal health and nutrition education; whether there is effective convergence among various departments, as intended.

The results are rather depressing. In terms of immunisation, the poor performance of the state as a whole (only 43 per cent for rural Andhra Pradesh according to the National Family Health Survey of 2005-06) is mirrored in the evidence from the audit. The most important shortcoming identified in the audit was the complete lack of co-ordination between the ICDS and the health personnel. Indeed, the advent of the new health workers ASHAs (Accredited Social Health Activists) appears to have demoralised anganwadi workers who now feel immunisation is not their job anymore. In general, through all the various functions of the ICDS, the study notes that observance of convergence objectives is more in the breach than in its practice. (page 54)

The health check-up function of the centres is severely compromised by lack of basic facilities in most centres, such as functioning of weighing machines or means to check for anaemia or blood pressure. While each anganwadi workers is supposed to be provided with a basic medicine kit, it was found that in the vast majority of centres, no kits had been supplied in the last one year. The audit also noted the failure of the health referral system.

In terms of nutritional supplement, a combination of confusion in the system about responsibility, as well as lack of material to be distributed, has meant serious under-provisioning. There has been widespread lack of supply of iron and folic acid tablets for pregnant women, as well as Vitamin A tablets for children, which has meant that many problems such as unsafe pregnancies, birth defects and vitamin deficiencies in children persist and are intensified.

Preschool education is an important part of the ICDS aims, but it has been adversely affected by the short opening hours of the centres, the many and often conflicting demands on the time of the anganwadi workers and helpers, and the lack of adequate training provided for such activities. Venugopal makes a strong and convincing case for converting all anganwadi centres into creches that function from 8.30 a.m. to 5.30 p.m., retaining all the current services with additional provision for serving supplementary nutrition thrice a day, doubling the strength of anganwadi workers and helpers, utilising the voluntary services of trained and willing adolescent girls and raising the honorarium of anganwadi workers for the longer hours of work. (page 65)

It is possible to go even further to argue that such workers should be paid just like all government employees, not relegated to honorarium that does not recognise the social importance and dignity of such work. Venugopal notes that anganwadi workers, to be effective, should reside in the village and receive proper remuneration as well as be trained for a minimum of three months and supervised, provided with proper facilities and motivated. He found new recruits to be full of commitment and motivation, a tremendous opportunity that should not be squandered.

All this necessarily requires a significant upscaling of the programme, but this is essential if the ICDS is to deliver on its promise, and deal with the still pressing problems of maternal and child health and nutrition. For this, obviously there has to be increased expenditure, but this should be seen in terms of essential public provision rather than a scheme on which the government is doling out a little bit of cash.

One of the important issues identified during the social audit is social discrimination, which casts its ugly shadow on this as in so much other public policy in India. All sorts of appalling instances are described: upper caste children not attending anganwadi centres that are located in the Scheduled Caste residential areas of the village; upper caste mothers and children not accepting food cooked by anganwadi workers and helpers from Scheduled Castes; anganwadi workers from upper castes not touching, feeding or playing with children form Scheduled Castes, and so on. Clearly, even making the ICDS more meaningful and actually inclusive requires larger social reforms to address what continues to be a very intractable problem in Indian society.

This insightful study also generates a number of very important and practical policy recommendations to make the ICDS a meaningful programme. These proposals have very wide applicability across India, and need to be seriously considered. This is essential if the ICDS is not to languish as yet another supposedly flagship scheme full of good intent but shoddy implementation.