Nurture mission

Odisha shows the way in the implementation of the ICDS scheme to ensure that children receive nutrition and care in their earliest years, but the Centre’s moves to slash budgetary allocations could wreak havoc on such programmes.

A child receives polio vaccine at a health centre in Bhubaneswar.

At the Tasarda anganwadi centre in Odisha’s Mayurbhanj district, as the auxiliary nurse and midwife (ANM) pulled out the blood pressure (BP) instrument to check a pregnant woman, the children at the anganwadi began playing “nurse”: with their little fists, they pumped an imaginary BP instrument and, a short while later, squealed with laughter as they let off the pressure with a “pphssss” sound. This, the most endearing moment of a survey of the Integrated Child Development Services (ICDS) scheme in the State, is significant for other reasons too.

The ICDS scheme is one of the main programmes of the Central government to provide child nutrition. Anganwadis are the delivery point for six essential services under the ICDS scheme: supplementary nutrition (SNP), immunisation, health check-ups, growth monitoring, antenatal care (ANC) and preschool education (PSE). For nutritional and educational attainments in later life, the first two to three years of a child’s life are the most important. Nutritionists have termed the first 1,000 days of a child’s life, starting in the mother’s womb, as the “window of opportunity” to prevent and even remedy under-nutrition. From that point of view, both the ICDS and maternity entitlements are important. The visit to the Tasarda anganwadi was part of the Odisha ICDS Survey in December 2014. We made surprise visits to nearly 50 anganwadis in four districts—Mayurbhanj, Bargarh, Ganjam and Koraput. At each centre, from the anganwadi enrolment register we randomly selected six mothers, three with children under three years of age and three with children aged three to six years. In Odisha, the anganwadi worker (AWW) and the anganwadi helper (AWH) are responsible for daily activities such as SNP and PSE. For the rest, there is a monthly schedule where the AWW works with the ANM and an accredited social health activist (ASHA).

In Tasarda, the ANM had come for her scheduled “Mamata Divas” or Nutrition Day initiative, where pregnant and lactating mothers receive care and young children are provided immunisation services. The scene at the Tasarda anganwadi was significant because it suggested that ANC activities, such as checking blood pressure, were done so regularly that the children had learned to imitate them. Indeed, one of the highlights of the survey was watching how well the team of front-line workers (the ANM, the AWW, the AWH and the ASHA) came together to cater to the diverse nutritional needs of young mothers and children.

In our survey, we found that most ICDS services were being provided at the anganwadi, though in varying degrees. Nearly all mothers (97 per cent) said their children got food at the centre; over three-quarters (76 per cent) of mothers of children under three (infants) said their children received immunisation; and only half of the women said there had been health check-ups. Among mothers of three-to-six-year-olds (toddlers), 76 per cent said their children had been weighed.

An overwhelming number of mothers, however, continue to associate the anganwadi with food, a place where the child gets eggs, dal and rice. For supplementary nutrition, one of the most encouraging initiatives of the Odisha government has been the introduction of eggs in the weekly menu: thrice a week for toddlers and twice a week (as take-home ration) for infants. Mothers of toddlers, on average, reported getting 2.4 eggs in a week; among mothers of infants, on average 1.5 eggs had been received.

The regularity of PSE activities at the anganwadis was another positive highlight of the survey: 85 per cent of mothers of toddlers said PSE activities were arranged at the anganwadi. This is a massive improvement over the figures reported in the National Family Health Survey (NFHS) 2005-06, where fewer than 30 per cent of the mothers said PSE activities took place. They appreciated the regularity of PSE activities, as going to the anganwadi enables children to cultivate the schoolgoing habit. At each centre, the teams requested children to sing a song—and children were able to do so at more than three-quarters of the centres.

Another metric to evaluate PSE activities at anganwadis could be comparing what children learn with what their learning potential is. Anyone who has spent time with a child in that age group knows what fast learners they are (for instance, they are at least as adept as adults at using smartphones). In fact, some mothers actually complained that there was not enough “teaching” activity at the centre. It was encouraging to observe that some mothers expected the centre to be more than just a place for dal -rice and eggs. Ultimately, public demand is the best way to bring accountability into any system.

Apart from provision of nutritious food and organisation of learning activities, immunisation, and antenatal care, growth-monitoring activities were also observed at the sample anganwadis.

Yet, there are several areas of serious concern. The main issue is corruption in the use of funds. In Odisha, the funds for supplementary nutrition (eggs, pulses, etc.) are credited into a bank account jointly operated by the AWW and a panchayat member. This decentralisation is a good practice. Earlier, when funds were routed through Child Development Programme Officers (CDPOs) at the block level, they demanded a cut from these funds.

However, we found that decentralisation was also subject to abuse. The amount credited is on the basis of enrolment at each anganwadi. If attendance is lower than enrolment, some money is left over. As there is no proper mechanism for squaring accounts, it appears that AWWs treat the leftover money as a top-up to their salaries.

In our survey, we matched attendance with official enrolment numbers and found that on average the gap is about 20 per cent. One can only hope that as awareness rises among parents, their children will attend anganwadis more regularly, thereby reducing the scope for cheating. Meanwhile, the government could undertake simple steps to prevent such misuse. For instance, AWWs could be asked to SMS the number of children present each day, and the supervisor or the CDPO could make random checks to verify the number of children present.

Another initiative of the Odisha government has been the “Mamata” scheme to provide maternity entitlements to pregnant and lactating mothers. The scheme is universal and provides for Rs.5,000 per pregnancy. Maternity entitlements are supposed to be a monetary compensation for wages foregone during a pregnancy and the lactating period. We also studied this as part of the Odisha ICDS Survey. In our sample villages, we found that coverage was reasonably high though far from universal. Two-thirds of eligible women had enrolled for the scheme. The cash transfer is credited to their bank accounts, and we found that the scheme worked reasonably smoothly. Yet, among the 200 Mamata beneficiaries we spoke to, we found that 6-10 per cent complained of corruption and one-fifth complained of delays in receiving the money.

The ICDS scheme, coupled with the maternity entitlements scheme, can make a real difference to the problem of child under-nutrition. In this context, the enhanced activity levels at anganwadis in Odisha are commendable. Behind this lies political will—the State has put more money into the scheme than mandated by the scheme’s guidelines—as well as a proactive administration. Of course, much more could be done to improve the scheme (for instance, dedicated buildings are sorely lacking), but the Odisha ICDS Survey shows that children are finally beginning to get their due.

The results of the survey in Odisha are significant in the light of the fact that both schemes—ICDS and maternity entitlements—are part of the National Food Security Act (NFSA), 2013, along with the public distribution system and the midday meal scheme. It is another matter that the Central government has not framed a national scheme for maternity entitlements nearly two years after the Act. And sadly, in this Budget, children seem to have received a bad deal. First, there is no additional allocation to expand maternity entitlements from its current coverage of 150 districts. Apart from violating the NFSA, this imposes an unnecessary burden on States such as Odisha and Tamil Nadu that run such schemes at their own cost. For a government that is otherwise so upbeat about cash transfers, this is particularly surprising. Second, this year’s allocation for the ICDS scheme is half of last year’s. The ICDS is one of the schemes directly affected by the recommendations of the 14th Finance Commission as the costs are to be shared by the Centre and the States. The Commission provides greater funds to States but cuts down on Central allocations. The implications of the change are not yet clear: it could eventually mean a shot in the arm for the ICDS if States use the greater resources at their disposal to increase allocation for the scheme.

These sudden and unexpected changes could wreak havoc on children’s programmes. To maintain the programme at its current operational level, State governments will have to readjust their budgets and make additional provisions to retain last year’s spending. If the flow of funds to States is not smooth, they are likely to suffer further. Moreover, since the ICDS is part of the NFSA, it is not clear if expenditures on account of a Central law can be palmed off to State governments in this fashion.

In his Budget speech, Finance Minister Arun Jaitley made a welcome announcement that tax exemptions, primarily benefiting the rich, would be scaled back next year onwards. Instead, the government proposes to reduce the corporate tax rate by 1 per cent each year starting next year. The Minister said he had wanted to initiate these changes from this year onwards but felt it “appropriate to give advance notice”. “Our stated policy is to avoid sudden surprises and instability in tax policy,” he said. Perhaps it would have been appropriate if he had shown such consideration for India’s future, that is, its children, too.

Reetika Khera is an associate professor of economics at the Indian Institute of Technology Delhi and Rajkishor Mishra is the State adviser to the Commissioners appointed by the Supreme Court in the Right to Food case .