Comprehensive reports on the implementation strategy, standard operating procedures and evaluation of the project
Undernutrition, including micronutrient malnutrition in children, adolescents and women of reproductive age, is rampant in India. The silent emergency is also estimated to result in potential GDP losses of 2-3% and an over 10% potential reduction in lifetime earnings for each malnourished individual.
India's Integrated Child Development Services (ICDS) is one of the world's largest programmes aimed at childhood development and care. The Tata Trusts have extended support to the Government of India, as well as the states, to implement nutrition-related initiatives targeted at building a robust ICDS system which can arrest malnutrition. Restructuring and strengthening ICDS services is one of the Trusts’ highest priorities.
In Maharashtra, from April 2017 to March 2021, the Tata Trusts supported the government to strengthen the ICDS programme and accelerate child development, covering 4,114 anganwadi (childcare centres) centres across three districts, ie, Chandrapur, Gadchiroli and Palghar.
The following reports on ‘Project Spotlight – Systems Strengthening of the Integrated Child Development Services in Maharashtra’ highlight the Trusts’ mission to strengthen the ICDS programme and accelerate child development in partner states.
Evaluation Reports of Chandrapur and Gadchirolli districts: This is a detailed Evaluation Report arrived at through two rounds of survey. Learnings from the project, as evaluated through an appropriate baseline (2019) as well as end-line survey (2021), are presented in the report. In line with the objective of the project, coverage of ICDS services and Knowledge, Attitude and Practices (KAP) of women are the main outcome indicators.
The report indicates that there has been a huge and statistically significant jump in mother’s and children’s dietary intake, food groups consumption, KAP, referral services as well as health and nutrition counselling services in the region.
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Peer reviewed publication on Maternal dietary diversity during lactation and associated factors in Palghar district, Maharashtra, India: “Dietary adequacy and diversity during the lactation period are necessary to ensure good health and nutrition among women and children. Behavioural interventions pertaining to health and nutrition counselling during both pregnancy and lactation are critical for awareness about dietary diversity. The issue assumes salience for marginalized communities because of the Covid-19 pandemic and associated economic and societal disruptions. This paper assesses the dietary patterns among 400 lactating mothers in the tribal-dominated district of Palghar in Maharashtra, India in 2020. The study is based on primary data regarding consumption across 10 food groups among women, based on a 24-hour recall period.
The primary outcome variable was binary information regarding ‘Minimum Dietary Diversity’ which is defined as consumption from at least 5 food groups. Econometric analysis based on multilevel models and item-response theory is applied to identify food groups that were most difficult to be received by mothers during the early and late lactation period.
We find that the daily diet of lactating mothers in Palghar primarily consists of grains, white roots, tubers, and pulses. In contrast, the intake of dairy, eggs, and non-vegetarian food items is much lower. Only half of the lactating women (56.5 percent; 95% CI: 37.4; 73.8) have a Minimum Diversified Diet (MDD). The prevalence of lactating women with MDD was higher among households with higher income (73.1 percent; 95% CI: 45.2; 89.9) than those in the lower income group (50.7 percent; 95% CI: 42.3; 58.9). Lactating Women (in early phase) who received health and nutrition counselling services are more likely (OR: 2.37; 95% CI: 0.90; 6.26) to consume a diversified diet. Food groups such as fruits, meat, poultry, fish, nuts, and seeds were among the rare food items in daily diet. The dietary pattern lacking in fruits, nuts, and heme (iron) sources indicates more significant risks of micronutrient deficiencies.
The findings call for improving dietary diversity among lactating mothers, particularly from the marginalized communities, and are driven by low consumption of dairy products or various fruits and vegetables. It was also found that among the different food items, the consumption of micronutrient-rich seeds and nuts is most difficult to be accessed by lactating mothers.”
Project Spotlight - Implementation Strategy: The first of the trio is the report on Implementation Strategy which documents the journey thus far and milestones achieved under Project Spotlight. An attempt is made to concisely present the operation framework under the project along with cumulative progress under each activity. It walks the readers through the burden of various determinants of child undernutrition in project geographies, implementation strategy adopted and activities identified to meet the objectives. In addition, it also presents the findings on changes observed in outcome indicators of the project by way of an evaluation study conducted by a third party in Palghar district.
Standard Operating Procedures on Refurbishment of Anganwadi Centres: This report details the SOP on Refurbishment of Anganwadi Centres, an activity which was implemented among others to allow anganwadi centres (AWCs) to function to their full potential. The report showcases the knowledge gained from the experience of refurbishing more than 100 anganwadis in the district of Palghar in Maharashtra, and systematically documents it from a hands-on implementation perspective. Specifically, an attempt has been made to document various steps in building essential infrastructure, locally and holistically. The report covers procedures on the selection of anganwadis, outlines specific activities to engage local panchayats and ways to leverage various forms of financing – all with the larger aspiration of bringing ownership at the local level. As underscored by the ICDS Commissioner, Maharashtra, in her foreword to the report, the goal is to provide a resource manual that can help organisations in more effectively undertaking implementation projects related to ICDS strengthening.
Palghar - Project Spotlight - End of Project Evaluation: This is a detailed Evaluation Report arrived at through two rounds of survey. Learning from the project as evaluated through an appropriate baseline (2018) as well as end-line survey (2020) is presented in the report. In line with the objective of the project, coverage of ICDS service and knowledge, attitude and practices (KAP) of women are the main outcome indicators. The report indicates that there has been a huge and statistically significant jump in children’s footfall in the AWCs, referral services, health and nutrition counselling services, as well as KAP among women.
Project Spotlight - Strengthening and Community Mobilisation, Maharashtra, impact figures
Services availed and knowledge, attitude and practices among pregnant women
- Percent point increase in referral services: 40.8%
- Percent point increase in health services availed: 31.1%
- Percent point increase in enrolment of women for availing AWC services: 26.4%
- Percent point increase in consumption of complete course calcium: 21.5%
Services availed and knowledge, attitude and practices among lactating women
- Percent point increase in referral services availed: 52.3%
- Percent point increase in health and nutrition services availed: 40.7%
- Percent point increase in counselling services availed: 38.7%
- Percent point increase in consumption of complete course of IFA: 34%
(*Period April – May 2018 and April – May 2020)
Publications in peer reviewed journals
Infrastructure for delivery of ICDS and Uptake of Preschool education services: Insights from Palghar, India (Joe et al, 2021) – This publication was published in Journal of Development Policy and Practice in June 2021.
The Integrated Child Development Services (ICDS) is a flagship programme of the Government of India and is delivered through a vast network of Anganwadi Centres (AWCs)—Courtyard Shelters — across rural and urban areas of the country. The ICDS is, however, affected by low coverage of various ICDS services, in general, and preschool education (PSE) services, in particular. This article aims to understand whether status of AWC infrastructure can have an effect on enhancing the coverage of PSE component. The article has twofold objectives: (a) to develop an AWC infrastructure index (AII), which can be applied to support programmatic monitoring and evaluation by ICDS and (b) to comprehend the association of AII with attendance and uptake of PSE services. Based on descriptive and econometric analysis of the AWC infrastructure data from Palghar (Maharashtra, India), it is demonstrated that better infrastructure is associated with higher PSE service coverage. The article concludes by highlighting the relevance of investing in AWC infrastructure, refurbishments and quality improvements to expand ICDS service coverage, particularly for the PSE services.
Findings were in lines with our findings from the short pre and post refurbishment survey.