ACKNOWLEDGEMENTS I am grateful to Directors of Department of women and Child Development, GOK for sponsoring the evaluation study of ICDS

in Karnataka. Special thanks are due to Ms. Vidyavathi, Ms. Sathyavathi, Mr. Jayaram Raje Urs, Mr. Gonal Bhimappa, other officials and functionaries who extended full co-operation. My sincere thanks to Sri D. Thangaraj, Principal Secretary, GOK, Department of Women and Child Development for discussing the recommendations at length and advising me suitably. I am indebted to Dr. M Govinda Rao (former Director), Dr. Gopal K Kadekodi (current Director) and Dr. A.S. Seetharamu, Professor Head of Education Unit, ISEC, for encouraging me to successfully complete the study. I express me sincere thanks to Sri Ranganath, Registrar, Sri Ramappa, Accounts Officer and Mr. Sharma, Deputy Librarian and their team who offered administrative support in conducting the study smoothly. But for the co-operation extended by the officials of ICDS at district and taluk levels as well as Anganawadi Workers, the evaluation study would not have been complete. I am highly indebted to them. I am thankful to Dr. (Ms.) R T Nanda and Dr.(Mr.) Lakkanna, Research Officers and Field Investigators and other members of project team for collecting data from villages in five districts in Karnataka.

Bangalore March 2004

M N Usha Project Director

ii

CONTENTS Chapter 1 2 3 4 5 Introduction Conceptual Framework of the Study Impact Assessment of Services Offered in ICDS Programme Problems Encountered by Functionaries of ICDS Summary, Conclusions and Recommendations Bibliography Appendix Volume II Particulars Page No. 1 4 17 30 39 43

iii

LIST OF TABLES Page Number Table 1: Number of Functionaries Sanctioned, In-position and Vacancies Table 2: Achievements in Training of Functionaries over the Years Table 3: Expenditure under Administrative Costs in ICDS in Karnataka Table 4: Expenditure Patterns on Training of Functionaries: Table 5: Nutritional Status of Children in ICDS in Karnataka Table 6: Children with Severe and Mild Malnutrition: Table 7: Live Births and Deaths of Children: Table 8: Birth and Death rates: Table 9: Beneficiaries of pre-school Education Programme within ICDS in Karnataka: Table 10: Indicators of Health and Quality of Physical Life (Karnataka and India) Table 11: Anaemia in Children in India and Karnataka Table 12: Anaemia in Women in India and Karnataka Table 13: NFHS Estimates of Region wise incidence of under nutrition (weight for age) among children under age three years 1998-99. Table 14: Districts, Blocks and Anganawadi centres selected for the Study: Table 15: Nutritional Programme in Karnataka: Expenditure and Coverage Table 16: Anthropometrics Indicators of Nutritional Status of children (India and Karnataka): 1998-99 Table 17: Infant Mortality Rates over years: Karnataka Table 18: Gender-wise Infant Mortality Rates: Karnataka Table 19: Nutritional Status of Women Table 20: NNMB Estimates of Chronic Energy Deficiency(CED) Among Adults in Rural Areas(% of Adults with BMI < 18.5) Table 21: Leading Causes of Maternal Deaths: Table 22:Maternal Deaths during Pregnancy/During Delivery /Within 6 weeks of Delivery: 2000 27 26 27 23 24 25 26 12 13-14 18 11 12 12 11 5 6 6 7 8 8 10 10

iv

LIST OF GRAPHS Page Number Figure1: Growth and Expansion of ICDS in Karnataka Figure 2: Coverage of Immunisation of Children Figure 3: Indicators of Health Figure 4: SNP Beneficiaries in the age group 0-6 years: Figure 5: SNP Beneficiaries, Pregnant and Lactating Women: Figure 6: Percentage of Girls Participating in PSE Activities Figure 7: Nutritional Status of Children in Bangalore Division Figure 8: Nutritional Status of Children in Belgaum Division Figure 9: Nutritional Status of Children in Mysore Division Figure 10: Nutritional Status of Children in Gulbarga Division Figure 11: Infant and Child Mortality (India and Karnataka) Figure 12: Trends in Infant Mortality Rates in Karnataka 4 9 11 17 18 20 21 21 22 22 24 25

EXECUTIVE SUMMARY

Integrated Child Development Scheme in Karnataka began as one of the pilot projects in India during 1975-76 in the Taluk of T.Narasipura in Mysore District. Since then there has been rapid expansion of the ICDS programme in the past two decades.

Currently there are 185 projects functioning in 175 taluks in 27 districts of Karnataka, out of which 166 are Rural, 10 Urban and 9 tribal projects and all projects belong to the central sector.

Objectives of the evaluation were to identify the factors that are operating for successful implementation of the programme, examine the constraints faced by the functionaries involved in the ICDS programme, study the impact of the package of services like Supplementary Nutritional Programme (SNP), Nutrition and Health Education, Immunisation and other services as well as to offer suggestions and recommendations for the improvement of the programme.

A survey design was used to select(randomly) six hundred Anganawadi Centres(which formed ten percent of total Anganawadi centres at the district levels) from ten blocks across five districts in Karnataka. These included Honnavar and Supa from Uttara Kannada District, Aurad and Bhalki from Bidar District, Hospet and Sandur from Bellary District, Bangalore Urban and Anekal from Bangalore District. Schedules were canvassed for Anganawadi workers and discussions were held among one hundred supervisors. Discussions were also held with CDPOs and Officials at the block and state levels. Descriptive statistical analysis was carried out to analyse the data.
vi

It was found that the ICDS programme was successfully implemented by a well knit administrative and organisational structure. Besides this, delivery of services such as Supplementary Nutritional Programme (SNP), Nutritional and Health Education, Immunisation, Health Check Up, Referral Services had resulted in the improvement of nutritional and health status of children and women over years. Inadequate infrastructure facilities and amenities for children in Anganawadi Centres were observed.

Strengthening of ICDS cell, providing infrastructure facilities in Anganawadi centres, offering orientation training to ZPs, TPs and GPs to take care of ECD programmes and organising mass campaigns to create awareness about child Rights were some of the recommendations made in the study.

vii

CHAPTER 1 Introduction
Integrated Child Development Scheme or ICDS, was launched in October 1975, as a programme of the fifth five year plan of India, to address the problems of persistent hunger and malnutrition especially among children. Since its inception, it is one of the largest programmes for promotion of maternal and child health and nutrition. It also included awareness building among pregnant and lactating women on pre and post natal care of children as well as non-formal education and care of children in 03-06 years of age. Education, Health and Nutrition were integrated in one package for the first time in India. ICDS was started initially in 33 blocks in 1975 and the programme has expanded rapidly since then and has currently reached 5,267 blocks covering all parts of India. According to the government, the programme caters to 33.2 million children and 6.2 million pregnant and lactating women.

Objectives of the Programme: The objectives of the ICDS scheme are

to improve the nutritional and health status of the children in the age group 0 to 6 years to lay the foundation for proper psychological, physical and social development of the child to reduce the incidence of mortality, morbidity, and malnutrition and school drop out to achieve effective coordinated policy and its implementation amongst the various departments to promote child development to enhance the capability of the mother to look after the normal health and nutritional needs of the child through proper nutrition and health education.

In order to meet the above objectives, ICDS involves in setting up anganawadi centres(AWCs), and these centres serve as platforms to implement the scheme in coordination with the functionaries of the health, education, rural development and other related departments. Each Anganawadi covers a population of around 1000 in rural, 1500

in urban and 300 in tribal areas. The anganawadis are meant to provide the following services: Supplementary nutrition to the children below 6 years of age, and nursing and pregnant mothers from low income families Nutrition and health education to all women in the age group of 15-45 years Immunisation of all children less than 6 years of age and immunisation against tetanus for all the expectant mothers Health check up, which includes antenatal care of expectant mothers, postnatal care of nursing mothers, care of new born babies and care of all children under 6 years of age Referral services of serious cases of malnutrition or illness to hospitals, upgraded PHCs/Community Health Services or district hospitals Non-formal pre-school education to children of 3-5 years of age.

Most of the studies which have looked into the functioning of the ICDS programme have recognised its positive role in the reduction of infant mortality rate, improved immunisation rates, increase in school enrolment and reduction in school drop outs. However, some of the indicators such as children born with low birth weight and severely stunted are not very favourable in Karnataka State. The problems generally noticed at the national level are lack of anganawadi workers, overloading of the tasks assigned to these workers, resources to meet the nutritional requirements etc.. In order to assess the situation and evaluate the programme in Karnataka, this study was taken up with the following objectives:

1. To identify the factors that are operating for successful implementation of the programme 2. To examine the constraints faced by the functionaries involved in the ICDS programme 3. To study the impact of the package of services Supplementary Nutrition Programme (SNP) Nutrition and Health Education Immunisation Health Check up Referral Services Non-Formal Pre School Education
2

The specific issues studied are 1) Whether the nutritional status of the children has improved? 2) How many malnourished children have moved to normal health status and over what period of time? 3) Is there any improvement in the nutritional status of the pregnant women? 4) Has nutritional scheme resulted in low / no risk delivery? 5) Has the incidence of low birth weight babies reduced? 6) What is the status of immunisation coverage? 7) Since immunisation is done at the anganawadi centres(AWC), has it made a difference? Is there improvement because of this? 8) Are health camps being conducted? 9) Have health camps resulted in reduction of health hazards to women? (not just reproductive health but also other hazards like TB etc..) 10) Is early detection of this being done? 11) What is the effectiveness of pre school education? 12) Proportion of children who attended Anganawadi schools go to regular school? 13) Is there an increase in the enrolment rate in rural primary schools? 14) Has the ICDS resulted in increase in girl child enrolment and decrease in drop out rates since she need not stay at home to take care of sibling's? 15) How do the children from the Anganawadis fare at regular schools, especially in terms of clear expression and thought, fluency in language etc..? 16) To offer suggestions and make a few recommendations to improve the effectiveness of ICDS programme in the State.

Overview of the Chapters: Background information about the ICDS programme in Karnataka and the conceptual framework of the study is presented in the second chapter. Inter district disparities in delivery of services, beneficiaries, nutrition and health status of children and women are presented in the third chapter. Problems encountered by Anganawadi workers forms the central focus of the fourth chapter. Issues related to ICDS programme in Karnataka are discussed in the fifth chapter. Summary, conclusion and recommendations are presented in the last chapter.

CHAPTER 2 Conceptual Framework of the Study

ICDS in Karnataka State: Growth and Expansion of ICDS Projects in Karnataka: Integrated Child Development Scheme in Karnataka began as one of the pilot projects in the Taluk of T. Narasipura in Mysore district. Since then there has been rapid expansion of the ICDS programme in the past two decades. The number of projects increased to 24 by 1979-80 and was spread to 20 districts. Between 1980-81 and 1989-90, 113 projects were added(more than quadrupled). The years 1982-83 and 1989-90 saw rapid expansion, when 29 and 28 projects were sanctioned respectively. In the next five years, 47 more projects were added to the existing ones.

At present there are 185 projects functioning in 175 taluks in 27 districts of Karnataka, out of which 166 are Rural, 10 Urban and 9 Tribal projects and all projects belong to the central sector. Figure1: Growth and Expansion of ICDS in Karnataka:

200 180 160 140 120 100 80 60 40 20 0

1975-76 Series1 1

1979-80 24

1989-90 137

1990-91 166

2000-01 185

Source: Office records of Department of Women and Child Development, GOK, various years

Anganawadi Centres:

During the year 2000, 39,993 Anganawadi centres(AWCs) were functioning covering 43.6 lakhs children below 6 years and were serving 7.3 lakhs pregnant women and nursing mothers. In recent years, the child population(0-6 years) has shown a slight decline following increasing practices of small family norms. This is also reflected in the target population of ICDS in Karnataka showing a marginal dip in pregnant mothers and nursing mothers during February 2001(7.1 lakhs), reporting of lowered number of deaths among infants(821) and children below 5 years(345) and less number of live births (48.2 thousands). During the year 2002, there were 40,133 AWCs functioning and covering a target population of 44,18,500 children and 7,38,493 pregnant women and nursing mothers. The number of posts sanctioned during 2000-01 are as follows:

Table 1: Number of Functionaries Sanctioned, In-position and Vacancies: Functionaries CDPO ACDPO Supervisors AWWs AWHs Training of Functionaries: sanctioned In Position Vacant 185 177 8 220 179 41 1861 575 1286 40170 39740 430 40172 40071 99

Source: GOK, Office of the Dept. of women and Child Development, Bangalore.

Training has been very valuable and significantly contributory input in achieving the aims and objectives of ICDS. The regional centre, NIPCCD at Bangalore has been the nodal centre for training personnel in ICDS. In addition, 23 Anganawadi training centres AWTCs (for anganawadi workers and anganawadi helpers) were established until 19871.

Training programmes may be classified as job training course(JTC) or Orientation course(OC), Refresher Course(RC) and training management of information system.

Following an evaluation study on the functioning of Anganawadi training centres, conducted in 1989, some centres were closed.

Table 2: Achievements in Training of Functionaries over the Years Training 1987-88 1988-89 1989-90 1999-00 2000-01 2001-02 Functionari (JTC) (JTC) (JTC) es CDPO 7 6 Nil 325 244 291 ACDPO 12 10 19 Supervisors 98 40 Nil 636 441 562 AWWs 1937 1181 547 38521 38330 AWHs 3129 7871 1909 33176 29478 34899
Source: Status Reports on ICDS in Karnataka as on 1-10-1989, GOK, Office of the Department of Women and Child development, Bangalore.

Investment in ECCE within ICDS: Finance for the implementation of the ICDS is made available largely from the central government and state government and partly released through the Zilla Parishad. International donors such as UNICEF and public contribution from community are other sources of finance for the programme. The UNICEF provided weighing machines, jeep, trailer, duplicator, typewriter, slide projector and slides. Contribution from public includes space for AWC, firewood and fuel, toys and play materials, teaching aids etc Expenditures can be classified as administrative costs, expenditure on SNP, and that on training of ICDS functionaries. Administrative costs: This includes (i) salary on functionaries and Honorariums for Anganawadi workers and that of monitoring cells at the district level; (ii) Recurring expenditure like rent, travel allowance for attending meetings, contingencies; (iii) nonrecurring expenditure such as furniture, books, materials for PSE activities, medical kit, etc..; (iv) POL for maintenance of vehicle. Table 3: Expenditure under Administrative Costs in ICDS in Karnataka (in Rs. Lakhs) Year Allocation Expenditure 1999-00 2000-01 7304.20 7813.70 6424.15 6655.20

Source: GOK, Office Records of Women and Child Development

Expenditure on SNP: The funding for the SNP component of ICDS is made by the state government budget. It covers procurement of food grains and transportation, fuel,
6

purchase of utensils, etc expenses of providing supplementary food have been worked out at the unit cost of Rs. 1.50 per day per beneficiary.

Expenditure on Training: Funds for training has been largely released by the GOI to the AWTCs/MLTCs under the Head of Account 2235-02-102-0-05(plan). Expenditure on training over the 4 years ending 2001-02 had quadrupled to Rs. 2.06 crores. Table 4: Expenditure Patterns on Training of Functionaries: (in crores of Rs.) 1998-99 1999-00 2000-01 2001-02 Cumulative Expenditure 0.43 1.57 2.14 2.06 6.20

Beneficiaries of ICDS: (a) Supplementary Nutrition Programme(SNP) SNP is a key component of the ICDS with infrastructure built to deliver nutrition supplements to children below 6 years and pregnant women and nursing mothers, in order that the infants and children grow to their full physical and mental capacities, have resistance to illness and diseases. The number of child beneficiaries identified is classified on the basis of age groups 0-3 years and 3-6 tears, gender, SCs, STs, OBCs, tribal and minorities, pregnant women and nursing mothers. (b) Nutrition Status: Improving the conditions of severe and mild malnourished children below 6 years has been the significant goal of ICDS and tremendous efforts have been geared towards the process of raising their conditions from malnourishment to recommended levels of nourishments. Target children have been weighed and measured for height periodically and growth charts prepared to identify the degree or grade of nourishment and monitor the progress of growth. Children are graded normal, I II, III and IV on the basis of their height and weight against their age. Grade III and IV indicates severely malnourished. Data from the office of the department of women and child development reveal (see table 5) that a decline in the number of severe or grade III malnourished children from 11683 children in 1999-00 to 10991 in 2000-01 and further reduced to 9036 by March 2002.

Table 5: Nutritional Status of Children in ICDS in Karnataka No. of Nutritional Status Anganaw adies 0-6 Normal Grade I Grade II beneficia ries 1999-00 39993 2397741 914492 891019 446051 (40.41%) (39.37%) (19.71%) 2000-01 40093 2452361 939996 879436 431203 (41.56%) (38.89%) (19.07%) 2001-02 40133 2476278 976713 890593 414198 (42.63%) (38.87%) (18.08%) Source: Department of Women and Child Development Year

Grade III Grade IV

11683 (0.52%) 10991 (0.49%) 8943 693 (0.39%) (0.03%)

Quarterly statistical reports from the Directorate of Health and Family Welfare Services(ICDS wing) also indicate (see table 6)that the percentage of 'mild' malnourished among ICDS children in the reported years below 6 years population had reduced from 11.84% in March 1998 to 10.44% in March 2001. In the case of 'severe' malnourishment, it was reported as being below 1% in all the 4 years. Table 6: Children with Severe and Mild Malnutrition: Year Rep. Below 6 Population Yrs 16662186 1894237 (11.38%) 24411122 2568153 (10.52%) 22692002 2392394 (10.54%) 26190529 2867495 (10.95%) Severely malnouris hed 4323 (0.23%) 6603 (0.26%) 4822 (0.20%) 6298 (0.22%) Mild malnouris hed 224274 (11.84%) 290393 (11.31%) 254324 (10.63%) 299227 (10.44%)

March 1998 March 1999 March 2000 March 2001

Source: Office of the State coordinator for ICDS and Director of Health and Family Welfare services, Bangalore. Quarterly Reports of 1998, 1999, 2000 and 2001

(c) Immunisation of Children Directorate of Health and family Welfare services is totally responsible for the immunisation of children and protecting them against diseases such as tuberculosis, diphtheria, whooping cough, tetanus, polio and measles. The Anganawadi worker works

along with the ANMs and LHVs to ensure that children in the AWC and pregnant women in the community are immunised as per schedule. Observations from the statistical data from directorate of health and family welfare services (ICDS wing) show that the percentage of achievement of target in immunisation has been fluctuating over the years 1996-97 to 2001-02. Only during the years 1996-97, 1997-98 and 2000-01 that the achievement levels has been above 70% of targets set for immunisation(see Figure 2). Figure 2: Coverage of Immunisation of Children

90% 80% 70% 60% 50% 40% 30% 20% 10% 0%

BCG 1996-97 1997-98 1998-99 1999-00 2000-01 2001-02 78% 86% 49% 57% 81% 64%

DPT 74% 77% 51% 54% 70% 60%

Polio 75% 82% 51% 58% 76% 61%

Measles 71% 77% 44% 54% 70% 57%

TT(II) 75% 81% 48% 57% 75% 57%

(d) Vital Statistics Number of live births and deaths of children below 1 year and below 5 years are significant indicators of health status. It has been observed from data from the office of the Department of women and child development that the reported number of deaths of children below 1 year and 5 years has reduced in the years 1999-00 to 2001-02(see table 8).

Table 7: Live Births and Deaths of Children: Year Reported Live Births 52691 46230 48120 Number of Deaths before one Year 1175 921 1076 Number of Deaths 1-5 Years 341 345 295

1999-00 2000-01 2001-02

Table 8: Birth and Death rates: Rep. Pop Below 6 Below 1 Live Birth Years Year Births rate 275999 (1.66%) 396720 (1.63%) 365739 (1.31%) 380888 (1.45%) 23603 28582 33417 35328 Death Death before 1 Rate year 17.01 599 25.38 14.85 17.67 16.19 701 777 653 24.53 23.25 18.48

March 1998 March 1999 March 2000 March 2001

16662186 1894237 (11.38%) 24411122 2568153 (10.52%) 22692002 2392394 (10.54%) 26190529 2867495 (10.95%)

Source: Office of the State Coordinator for ICDS and Directorate of Health and Family welfare services, Bangalore. Quarterly Reports of 1998, 1999, 2000 & 2001

(e) Non Formal Pre-School Education: In Anganawadi Centres, pre-school activities include non-formal and play way methods of teaching/learning vocabulary, pronunciation, identifying numbers and alphabets. It equips children of the age group 3-6 years for reading and writing readiness During 1999-00 there were 39,833 AWCs providing Pre school education activities for 210 days and covered 6,42,862 boys an 6,39,881 girls. During 2000-01, about 6,48,988 boys and 6,42,926 girls attended the Pre school education activities conducted in 40,093 centres but in 2001-02, although the number of AWCs offering Pre school education rose to 40,133 the number of boys increased to 6,57,940 as against 6,27,872 girls(see table 9).

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Table 9: Benificiaries of pre-school Education Programme within ICDS in Karnataka: Year No. of Anganawadies Beneficiaries of PSE Girls 639881 (49.88%) 642926 (49.77%) 627872 (48.83%) Total 1282743 (53.5%) 1291964 (52.7%) 1285812 (51.9%)

1999-00 2000-01 2001-02

Boys 39993 642862 (50.12%) 40093 648988 (50.23%) 40133 657940 (51.17%)

Source: Reports of Office of the Department of Women and Child department, GOK, Bangalore

Table 10: Indicators of Health and Quality of Physical Life: 2001(Karnataka and India) Indicator Karnataka India 1. Birth Rate Rural 23.7 Urban 19.2 Combined 22.3 2. Death Rate Rural 8.7 Urban 5.5 Combined 7.7 3. Infant Mortality Rate Rural 70 Urban 25 Combined 58 Figure 3: Indicators of Health, 2001:

27.6 20.8 26.1 9.4 6.3 8.7 77 45 72

Source: Population projections for India and states, 1996-2016, RGI, 1996. (Economic survey, p-284, 2001-02)

80

70

60

50

40

30

20

10

0 B ir th R ate D eath R ate K arn atak a In d ia In fan t M ortality R ate

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Indicators of nutrition for women and children based on NFHS-2 survey indicate that the prevalence of severe anaemia is very high in Karnataka i.e., 7.6%, which is second highest among all the Indian states , first being Rajasthan (table 11). Though NFHS did not go into the details to find the reasons for high severe anaemia at the State level, it broadly finds that, children from households with a high standard of living, children whose mother completed at least a high school education, and children whose mothers are not anaemic have anaemia rates that are substantially below the national average (for more details see NFHS-2 survey reports). It can also be seen that severe anaemia among women is also higher than the national average (table 12). Here again the main reasons are low intake of dietary iron, poor absorption of iron due to inhibitors and increased demand due to the physiological requirements of menstruation, pregnancy and lactation. Table 11: Anaemia in Children in India and Karnataka* Percentage of Children with Anemia Any Anemia Mild Moderate Severe Anemia Anemia Anemia 74.2 22.9 45.9 5.4 70.5 19.6 43.3 7.6

India Karnataka

*% of children 6-35 months of age classified as having anaemia by State and selected metropolitan areas, India, 1998-99 Source: Economic and Political Weekly, February, 14, 2004, p668.

Table 12: Anaemia in Women * in India and Karnataka Percentage of women with Anemia Any Mild Anemia Moderate Severe Anemia Anemia Anemia 51.8 35.1 14.8 1.9 42.4 26.7 13.4 2.3

India Karnataka

*percentage of ever married women in the age group 15-49 classified as having anaemia by State and selected metropolitan areas, India, 1998-99 Source: Economic and Political Weekly, February, 14, 2004, p668.

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Table 13: NFHS Estimates of Region wise incidence of under nutrition(weight for age) among children under age three years 1998-99.

Severe Under Nutrition

Rural Urban All

Moderate Under Nutrition

Rural Urban All

Under Nutrition(Severe + Moderate)

Rural Urban All

India Karnataka

20.3 20.1

12.0 10.5

18.4 30.2 17.0 27.2

27.0 28.5

29.4 27.6

50.5 47.2

39.0 39.0

47.8 44.6

Source: IIPS, NFHS-2 Survey Report, Karnataka.1998-99.

Framework of the Study: One of the most commonly used techniques that helps programme planners and evaluators of early childhood development programmes is known as a Logical Framework Analysis (Log frame). This is a tool that provides a structure for specifying the components of evaluation and the logical links between the components of a project. The Log Frame can offer a way of logic of plan of action and its evaluation. The basic framework is four-by-four table comprising of the following:

Matrix Goals Objectives Output Inputs/Activities

Description of the Study Area: Karnataka State is located in southern part of India and spreads across 191,791 sq.km. It has 27 districts and 176 taluks. For administrative purposes the State is divided into four revenue divisions:viz.. Bangalore, Belgaum, Gulbarga and Mysore Divisions. From each administrative divisions a district was chosen based on HDI, GDI and female literacy rates. Bangalore Urban District from Bangalore division, Uttar Kannada District from Belgaum division, Bidar and Bellary districts from Gulbarga division and

Chamarajanagar district from Mysore division are chosen for the study. Two blocks from each district are chosen randomly. With due regard to agro-climatic patterns no district was to be selected on a purposive basis. The chosen blocks cover coastal, forest, tribal, dry & backward, partly wet and urban areas. In order to cover ten percent of total number
13

of anganawadi centres from each block, villages were selected in the first stage and in the second stage anganawadi centres were selected randomly. In all six hundred anganawadi centres were selected in the study. The following table provides the details of the district, block and the number of anganawadi centres chosen for the study. Table 14: Districts, Blocks and Anganawadi centres selected for the Study: District Division Block Type No of Centres 1 Bidar Gulbarga Aurad Bhalki 2 Bellary Gulbarga Hospet Sandur 3 Chamarajanagar Mysore Gundlupet Dry & backward Dry & Backward Partly wet & dry Partly wet & dry Tribal 49 67 67 70 40 68 50 70 119

Chamarajanagar Tribal 4 Uttar Kannada Belgaum Supa Honnavar 5 Bangalore Urban Bangalore Bangalore Anekal Total Forest Coastal Slums & city Slums & city

600

Design and Tools used in the Study: The study used a survey design to collect both quantitative and qualitative data. Both secondary and primary data were collected for the study. Office records in Department of women and Child development and Directorate of Health and family welfare were the main sources of secondary data related to ICDS programme. Information was gathered from State offices, district level offices and block level offices. Data collected from Anganawadi centres, through schedules, formed the primary source of data. Schedules for CDPOs, ACDPOs and Anganawadi Workers:
14

Based on their job responsibilities the questions were framed and he schedules for CDPOs and ACDPOs were prepared A detailed schedule was designed for eliciting information from anganawadi workers. It had two parts. First part dealt with general background information about the AWCs. Second part covered the background information about educational attainment, work experience, nature and type of training undergone, extent of awareness about the medical /health personal attached to AWCs, number of health education and nutrition demonstration classes organised, home visits made, co-operation sought from community members to organise baby show, enrolling children to AWCs and primary schools, participation in village education committees and other meetings held at village level, issues raised in such meetings and supervision done by officials, supervisors and other authorities. Besides these problems encountered by anganawadi workers were elicited in detail. Further details regarding the number of children benefiting from SNP, pregnant and lactating women beneficiaries and students enrolled in PSE are also obtained from each anganawadi centres as per the tables outlined at the end of the schedule. These schedules were canvassed in kannada and a copy of it is reproduced in the appendix.

Volume II of the report consists of data on the following issues at district and taluk levels. Format I consists of information on number of anganawadi centres, details regarding the staff strength in terms of number of supervisors, anganawadi workers and helpers and also the financial status of the anganawadis at the district level. Format II provides information at taluk level on the number of anganawadis providing supplementary nutrition programme(SNP), number of SNP beneficiaries in the age group 0-3 years, 3-6 years, pregnant and lactating women, Number of PSE beneficiaries (boys and girls) and the nutritional status of the children. The next set of tables are related to the vaccination and child health i.e., information on vaccination received by pregnant women, number of children receiving BCG, DPT3, OPV3, measles, DPT booster etc.., number of institutional deliveries, maternal deaths, vitamin doses received by children and details regarding childhood diseases and referral services. From these data we notice that in the districts Dharwad, Davangere, Bellary and Bijapur each anganawadi covers 1500 population as against the norm of 1,000

population per anganawadi. However the distribution of anganawadis is quite good in Kodagu, Chickmagalur and Chamarajnagar districts.
15

Supplementary Nutritional Programme was well established in Chickmagalur, Kolar and Hassan districts where more than 75 percent of the eligible children in the age group of 0-6 years were getting the benefits, whereas share of beneficiaries were as low as less than 40 percent in Raichur, Bellary and Bijapur districts.

Districts Udupi, Dakshina Kannada and Chickmagalur were utilising the benefits, under a component of SNP programme meant for pregnant and lactating women, very effectively (i.e., more than 80%). Raichur and Bijapur lags behind even in this case.

Districts Udupi, Tumkur, Mandya and Mysore witnessed very less number of severely malnourished children, whereas Bellary, Koppal, Gulbarga and Raichur possessed more number of malnourished children.

Even the death rate of children before attaining the age of 5 years is quite low in Chickmagalore and Udupi districts as against the high rates in Raichur Gadag and Gulbarga districts.

These findings lead to a conclusion that the districts which are actively involved in SNP programme show low malnourished children and less number of deaths among children i.e., before attaining the age of 5 years which clearly implies the success of SNP programme.

Further it is observed that the generally backward districts of the Hyderabad Karnataka region in the State Viz Raichur, Bidar, Gulbarga, Bellary and Koppal are also relatively poor in performance in ICDS project. They need additional attention in future.

16

CHAPTER 3 IMPACT ASSESSMENT OF SERVICES OFFERED IN ICDS PROGRAMME

Supplementary Nutrition Programme (SNP)
Inter district disparities were observed in terms of coverage of beneficiaries of SNP programme among children. Share of the benificiaries in the age group 0-6 years ranged from 0.78 to 0.37 (see Figure 4). Districts such as Chickmagalur, Bangalore-rural, Kolar, Hassan and Tumkur occupied first five positions in terms of coverage of children in the age group of 0-6 years. Raichur, Bellary, Bijapur, Gulbarga and Koppal occupied last five positions. Variation with respect to the share of beneficiaries among the pregnant and lactating women was also quite high and ranged from 0.88 to 0.39 (see Figure 5). Districts of Udupi, Dakshina Kannada,

Chickmagalore, Kodagu and Kolar occupied the top positions with regard to coverage of Pregnant women /Lactating women. Figure 4: SNP Beneficiaries in the age group 0-6 years:

SNP Benificiaries(Share of children benifited in the age group 0-6 Yrs):

0.90

0.80 0.78 0.78 0.77 0.72

0.70

0.70

0.70

0.70

0.71

0.69

0.67

0.65

0.64

0.61

0.59

0.60

0.63

0.58

0.58

0.55

0.51

0.50

0.53

0.48

0.46

0.46

0.44

0.44

0.40

0.44 Bellary Raichur 0.37

0.30

0.20

0.10

Dakshina kannada

Uttar kannada

Mandya

0.00 Chikmagalur Chamarajnagar Bangalore-R Kolar Hassan Tumkur

Davanagere

Bagalkot

Gulbarga

Chitradurga

Bangalore

Udupi

Haveri

Kodagu

Mysore

Belgaum

Shimoga

17

Dharwad

Bijapur

Gadag

Koppal

Bidar

Figure 5: SNP Beneficiaries, Pregnant and Lactating Women:

SNP Benificiaries: (Share of Pregnant & Lactating women Benificiaries)

1.00

0.90 0.88 0.86 0.85 0.85 0.83

0.82

0.81

0.80

0.71

0.71

0.70

0.80

0.80

0.69

0.67

0.61

0.60

0.63

0.59

0.59

0.58

0.52

0.50

0.57

0.47

0.47

0.47

0.47

0.40 Haveri Chamarajnagar Davanagere Bangalore-r Dharwad Bangalore Mandya Mysore Bellary Kolar Chitradurga Bagalkot Hassan Bidar Uttar kannada Chikmagalur Dakshina kannada

0.40

0.46

0.30

0.20

0.10

0.00 Gulbarga Shimoga Belgaum Kodagu Raichur Tumkur Bijapur Koppal Gadag Udupi

Table 15: Nutritional Programme in Karnataka: Expenditure and Coverage Year 1990- 1991- 1992- 1993- 1994- 1995- 1996- 1997- 1998- 1999- 200091 92 93 94 95 96 97 98 99 00 01 1281 1673 1875 2056 2388 2888 2893 2902 2862 3099 3113

SNP Beneficiaries Expenditures 709.1 661.1 894.5 1035.8 1698.2 2999.2 3515.9 3608.0 3249.4 3873.4 4734.4 (in Rs. Lakhs) Source: Directorate of women and child Development(A-96, Economic Survey 2001-02)

18

0.39

Immunization of Children and Pregnant Women Immunization status of children is presented in Tables(IM1 to IM3). Inter district

variations are found across gender as well as age and type of doses given to children. Similarly, inter district disparities were observed in terms of first and second dosages given to Pregnant Women. Health Check Up and Referral Services Health Check up of children undertaken at the state level had been reported as 75009 boys as against 73920 girls in the age group 0-3 years. Similar figures in the age group 36 years were 130792 boys as compared to 129247 girls. Pregnant Women (22464) and Nursing Mothers (19494) have had their Health Check ups by ANMs/LHVs/MOs according to the information obtained by the Directorate of Health and Family Welfare, Bangalore during the last year. Inter-District variations were found in terms of health check up among children of different age drops as well as Pregnant women and Nursing mothers. Mothers (112620) and Children (Boys 9502 and Girls 8827) had been referred to SubCentres during the last year. Inter District Variations were also found in the referral services too. Non-Formal Pre-School Education Children in the age group 3 to 6 years were covered under non-formal pre-school education. Participation of girls and boys were almost same. Participation rates of girls had increased over years. Disparities were observed across gender as well as regions. Impact Assessment of the Programme A: Nutritional Status of Children Nutritional Status of children may be assessed in terms of three anthropometrics indicators, viz., weight-for-age, height-for-age and weight-for-height. These three

measures are compared with the corresponding median for the international reference population recommended by the World Health Organization and expressed in standard deviation units (z-scores). Children are considered undernourished (severely under

nourished) if they fall short of the reference median on any of these measures by more than two (three) standard deviations. Information available from the National Family Health Surveys could be used to assess the status in Karnataka.

19

In 1998-99, by the weight-for-ages index (a composite measure of chromic and acute under nutrition), 43.9 per cent of children fewer than three years of age were underweight as against the all-India-estimate of 47 per cent. But it was the highest among the south Indian states and 9th highest rank among the sixteen major states. Height-for-age provides a measure of linear growth retardation (stunting). By this index, 36.6% were stunted in Karnataka as against the All India figure of 45.5%. Karnataka happens to be the second highest among the four southern states and third lowest among sixteen major States. By these two indices, incidence of severe under nourishment in Karnataka was less than the all India level. The third index, that is, weight-for-height, is a measure of body mass relative to body length. Incidence of wasting was higher in Karnataka (20% than that of All India or any other South Indian states. With respect to this indicator Karnataka ranks fourth highest among the major states. This high incidence of low birth weight can be attributed to poor nutritional conditions of the mothers. Lack of ante natal care during pregnancy and lack of access to safe delivery facility would add up to the reasons for the poor performance of the nutritional related indicators for children in Karnataka. Figure 6: Percentage of Girls Participating in PSE Activities:

Uttarkannada 4% Udupi 4%

Bagalkote 2% Bangalore Rural 4% Bangalore Urban 4% Belgaum 4% Bellary 4% Bidar 4% Bijapur 4%

Tumkur 4% Shimoga 4% Raichur 4% Mysore 4% Mandya 4% Koppal 4% Kolar 4% Kodagu 4% Haveri 4%

Girls %
Chamarajnagar 4% Chikmagalur 4% Chitradurga 4% Dakshina kannada 4% Gulbarga 4% Gadag 4% Davangere 4% Dharw ad 4%

Hassan 4%

20

Figure 7: Nutritional Status of Children in Bangalore Division:

Nutritional Status of Children in Bangalore Division

45

40 35 30

25 20

15 10

5 0 Grade I Grade II Grade III Grade IV

Bangalore(U) 39 13 0.10 0.00

Bangalore(R) 38 12 0.10 0.00

Chitradurga 41 19 0.10 0.00

Davangere 42 20 0.10 0.00

Kolar 38 16 0.10 0.00

Tumkur 39 9 0.10 0.00

Shimoga 44 13 0.10 0.00

Figure 8: Nutritional Status of Children in Belgaum Division:

Nutritional status of children in Belgaum Division

40

35

30

25

20

15

10

0 Grade I Grade II Grade III Grade IV

Belgaum 35 18 0.23 0.03

Bijapur 38 24 0.20 0.03

Bagalkot 38 24 0.23 0.03

Gadag 35 23 0.24 0.04

Dharwad 36 16 0.44 0.05

Haveri 40 22 0.31 0.04

Uttar Kannada 40 11 0.18 0.02

21

Figure 9: Nutritional Status of Children in Mysore Division:

Nutritional status of children in Mysore division

45 40 35 30 25 20 15 10 5 0

Chamarajna Chickmagal gar ore 43 11 0.07 0.00 38 9 0.06 0.02

Dakshina Kannada 36 9 0.06 0.01

Hassan 43 7 0.11 0.01

Mandya 36 8 0.04 0.00

Mysore 42 15 0.06 0.01

Kodagu 34 8 0.09 0.04

Udupi 34 7 0.02 0.01

Grade I Grade II Grade III Grade IV

Figure 10: Nutritional Status of Children in Gulbarga Division:

Nutritional Status of children in Gulbarga division

40

35

30

25

20

15

10

0 Grade I Grade II Grade III Grade IV

Bellary 38 31 1.41 0.23

Bidar 36 34 0.33 0.01

Gulbarga 37 27 1.14 0.05

Raichur 38 32 0.99 0.09

Koppal 37 32 1.37 0.12

22

Table 16: Anthropometrics Indicators of Nutritional Status of children (India and Karnataka): 1998-99

India Karnataka

Weight-for age Height-for-age Weight-for-height Percenta Percenta Percenta Percenta Percenta Percenta ge below ge below ge below ge below ge below ge below - 2SD* -3SD - 2SD* -3SD - 2SD* -3SD 18.0 47.0 23.0 45.5 2.8 15.5 16.5 43.9 15.9 36.6 3.9 20.0

Note: * includes children who are below -3SD from the international Reference population median. Source: International Institute for population science and ORC Macro(2000): National Family Health Survey(NFHS-1, 1998-99: India, IIPS, Bombay. P-270) (Economic Survey 2001-02, P.324)

B. Infant Mortality Rates

Infant mortality: This index measure the probability of dying before exact age one expressed per thousand live births. Child mortality: This is the probability of dying between the first and fifth birthday expressed per thousand live births. Under-five mortality: The probability of dying between birth and exact age five

expressed per thousand live births.

Infant and child mortality rates indicate quality of life in the society. All these indicators show improvement between 1992-93 and 1998-99, infant mortality rate in Karnataka (51.5 per 1000 live births) was lower than that of all-India (67.6 per thousand live births). Similarly, child mortality in Karnataka 19.3 per thousand live births) was less than allIndia average (29.3 per thousand live births). So was the case with under five mortality rates, which were 69.8 in Karnataka as against 94.9 per thousand live births at the allIndia level. The state has remained polio free this year. A declining trend in IMR in Karnataka is seen(table 17). The decline is from 67 in 199495 to 53 in 2000-01. However this decline is mainly due to the decline in the IMR rates in Urban areas(see table 18). Rural Infant mortality rates are quite high compared to urban and it remained more or less constant over the period. Further, it may be noted that there is a decline in the male IMR from 87 in 1981 to 74 in 1991 but with respect to female

23

IMR the decline is negligible i..e., from 74 in 1981 to 72 in 1991. This calls for concerns towards Rural and Female mortality rates.

Figure 11: Infant and Child Mortality (India and Karnataka):

120

100

80

60

40

20

0 1992-93 1998-99 1992-93 1998-99 Infant Mortality Infant Mortality Child Mortality Child Mortality India Karnataka 78.5 65.4 67.6 51.5 33.4 23.5 29.3 19.3

1992-93 Under Five Mortality 109.3 87.3

1998-99 Under Five Mortality 94.9 69.8

Source: International Institute for population science and ORC Macro(2000): National Family Health Survey(NFHS-1, 1998-99: India, IIPS, Bombay. P-270) (Economic Survey 2001-02, P.324)

Table 17: Infant Mortality Rates over years: Karnataka Year 1994-95 1995-96 1996-97 1997-98 1998-99 1999-00 2000-01 67 Infant Mortality 62 50 53 58 55 53 Rate
Source: Office Records of Department of Health and Family Welfare Services over years:

24

Figure 12: Trends in Infant Mortality Rates in Karnataka:

70

60

50

40

30

20

10

0 Rural Urban

1995 69 43

1996 63 25

1998 63 24

1999 70 25

2000 68 24

Source: Estimates of IMR as reported by Registrar General of India

Table 18: Gender-wise Infant Mortality Rates: Karnataka Year 1981 1991 Male 87 74 Female 74 72

Source: Office of the Registrar general of India. (occasional paper No. 5 of 1993).

C: Nutritional Status of Women

A widely used indicator of nutrition status is the body mass index (BMI), which is defined as the weight in kilograms divided by the height in metres squared (Kg/m2). This
25

indicator is used to assess both thinness and obesity. Nutrition status of women in Karnataka was 39.4% (with BMI <18.5 kg/m2) and 13.7% (with BMI of 25.0 kg/m2 or more). It was slightly above the figures of India.

Nutrition status of women is reported by NNMB, which provides gender related chronic energy deficiencies (CED) among adults. Pooled BMI for rural population was 45.5 for males as against 47.7 females during 1996-97 (pooled BMI estimate is based on the BMI estimates of seven states Kerala, Karnataka, Tamil Nadu, Andhra Pradesh, Maharashtra, Gujarat and Orissa). Karnataka had CED among females around 41.7 as against 36.2 males as per 2000-01 data out of which tribal population had more incidence of CED. In 1998-99, CED estimates for total population in rural areas (which had tribal population) was 53.4 for females as compared to 47.2 males.

Table 19: Nutritional Status of Women Total Women living in Urban households with a high standard of living

% with BMI < % with BMI of % with BMI < % with BMI of 18.5 kg/m2 25.0 kg/m2 or 18.5 kg/m2 25.0 kg/m2 or more more India Karnataka 36.2 39.4 10.6 13.7 12.2 9.1 35.7 42.2

Source: Arnold, Fred(et..al) 2004: Indicators of Nutrition for Women and Children: Current Status and Recommendations, Economic and Political Weekly, Feb 14, p667.

Table 20: NNMB Estimates of Chronic Energy Deficiency(CED) Among Adults in Rural Areas(% of Adults with BMI < 18.5) Rural Population (2000-01) Tribal Population (1998-99) Males Females Males Females Karnataka Pooled 36.2 41.7 47.2 53.4 37.4 39.4 49.3 55.4

Source: National Institution of Nutrition(1991, 1993, 1999, 2000 & 2002) and NFHS, India and Karnataka, cited by Radhakrishna R and Ravi C(2004): Malnutrition in India-Trends and Determinants, Economic and Political Weekly, Feb 14, p673.

26

D: Maternal Mortality Rates and Leading Causes of Maternal Deaths

Maternal Mortality Rate is one of the indicators that reveal the nutrition status of pregnant women and women after child delivery. Table 21: Leading Causes of Maternal Deaths: Sl.No Name of the leading cause 1 All types of Abortion Number of Deaths 1993 1994 1995 47 42 39 (9.3%) (9.3%) (8.4%) 141 76 86 (27.8%) (16.7%) (18.6%) 135 136 125 (26.6%) (30.0%) (27.0%) 47 55 54 (9.3%) (12.1%) (11.7%) 50 73 85 (9.9%) (16.1%) (18.4%) 46 (9.1%) 41 (8.1%) 507 (3.6%) 39 47 (8.6%) (10.2%) 33 (7.3%) 454 (3.3%) 27 (5.8%) 463 (3.3%)

2 Hemorrhage of pregnancy & Child Birth

3 Toxemia of Pregnancy

4 Obstructed Labour

5 Complication of Puerperium

6 All other direct obstetric causes

7 All other causes of maternal deaths

8 Total maternal deaths

9 All other female deaths

13705 13268 13492 (96.4%) (96.7%) (96.7%) 14212 13722 13955

10 Total female deaths

Source: Office Records of Directorate of Health and Family Welfare

Table 22:Maternal Deaths during Pregnancy/During Delivery /Within 6 weeks of Delivery: 2000 During pregnancy During Delivery Within six weeks of delivery 220 393 677

Source: Office Records of Directorate of Health and Family Welfare

27

During 1993, percentage of maternal deaths was 3.6 which marginally declined to 3.3 percent in 1995. Mostly the cause of maternal death was due to toxaemia of pregnancy and haemorrhage of pregnancy and child birth during 1993, whereas during 1995, maternal deaths due to toxaemia of pregnancy is the leading cause. In the early 2000s, maternal deaths during pregnancy were lesser than that during delivery but maternal deaths within six weeks of delivery had increased (52.48% out of total maternal deaths). It is interesting to note that out of the total deliveries (870564), 491432 deliveries had taken place in institutions as compared to 5421 deliveries carried out by untrained attendants.
Pregnancy Outcome

Total number of births of children was 870564, number of live births was 855544 and number of still births 15020. Distribution of weight of new born was 147173 (<2.5 kg); 647086 (>2.5 kg) and 61285 (weight unknown). With regard to neo natal care, number of sick new born children treated were 32350 and 19671 cases referred to medical attention. Nearly 826120 women had received three check ups for post natal care. Figures related to under five mortality rates revealed that out of 200019 children, child deaths had occurred within one week of birth (42.51%), one week to one month of birth (15.58%), one month to one year of birth (26.85%) and one to five years of birth (15.06%).

E: Participation of Girls and Boys in Pre School Education

Children who attain six years of age enrol themselves in primary schools. Before that they gain anganwadi experiences by way of participating in non-formal pre-school education. About 32% of children participate in Non-formal pre-school Education related activities organized in Anganwadi Centres. Ratio of Boys and girls in 1:0.99 that is per 100 boys 99 girls participate in pre-school activities. Almost equal number of boys and girls participate in activities of pre-school education within AWCs.

Variations in Performance in ICDS: Results based on Primary Data:

In terms of performance indicators Uttar Kannada district occupied first position. Bidar, Bellary and Chamarajanagar districts followed this. Bangalore (Urban) exhibited low performance.

Infrastructure facilities in AWCs were better in Honnavar and Supa (Joida) taluks of Uttara Kannada. So also participation rates of children and PW and NM in immunization and SNP 28

programme were high. However, the food supply was not regular owing to administrative lapses. Hospet and Sandur taluks in Bellary had higher rates of participation rates of children and women in health related programmes and the number of malnourished children had come down. In Aurad taluk participation rates of children in immunization was limited as compared to that of Bhalki Taluk in Bidar district. SNP programme was not well received by children and PW and NMs in both the taluks of Bidar District. In Chamarajanagar District, in Chamarajanagar and Guldlupet taluks immunization coverage was partial and participation rates of tribal children was lesser as compared to children belonging to SCs, OBCs and Minorities. Participation rates of children and PW and NMS in SNP were not satisfactory. In Bangalore urban areas the coverage of SNP was satisfactory and the participation rates of children and NMs and PW in immunization programme were lesser in slums as compared in rural areas in Anekal taluk, where the rates were higher. In terms of minimizing the malnutrition among children as well as transfer from one grade to another Bellary had exhibited better performance than the other districts. Analysis at taluk level reveal that Supa had performed better than Honnavar taluk in UK; Sandur performed better than Hospet in Bellary district; Gundlupet had performed better than Chamarajanagar Taluk in Chamarajanagar District; and in Bangalore Urban, the State sector had performed better than the central Sector.

Effective supervision by Supervisors and Officials had contributed to better performance in UK, Bellary and Bidar districts. Chamarajanagar district had shortage of supervisors, which came in the way of successful supervision of AWCs. In the case of Bangalore Urban areas the supervisors had not performed the tasks assigned to them. In general, in all the districts except Bellary district, Medical and Health officials and their team of staff including ICDS doctors had not cooperated well with the AWWs. AWWs in almost all the districts and taluks (selected for the study) were overburdened with additional responsibilities and were devoting less attention to ICDS programme.

29

CHAPTER 4 PROBLEMS ENCOUNTERED BY FUNCTIONARIES OF ICDS

Perceptions and Problems of Anganwadi Workers A detailed schedule was designed for eliciting information from AWWs. It had two parts, Part-A dealt with general background information about the AWCs. Part-B consisted of 16 questions. It covered the background information about educational attainment, work (job), experience, nature and type of training undergone, extent of awareness about the medical / health personal attached to AWCs, number of health education and nutrition demonstration classes organized, home visits made, cooperation sought from community members to organize baby slow, enrolling children to AWCs and primary schools, participation in Village Education Committees and other meetings held at village level issues raised in such meetings and supervision done by officials, supervisors and other authorities. Besides these problems encountered by AWWs were elicited in detail.

Part C and Part D Comprised of checklist items (10 and 4 respectively) to gather information from AWWs as to how they are involved in planning and management of ICDS by officials and authorities and job satisfaction and their involvement in Anganwadi Association and Forums. Further, AWWs were asked to offer suggestions for the qualitative improvement of ICDS programme in general and delivery of services in particular.

Supplementing the schedules interviews, discussions and dialogues were carried out with a selected few AWWs who expressed their views frailly and boldly.

1. Anganwadi workers about 20% were below SSLC; 30% were matriculates and had undergone short-term training; 50% were matriculates and had undergone both short term and long-term training. 2. Age range of AWWs was from 19 years to 39 years. About 30% of AWWs were in the age group 26 to 30 years; 63% belonged to the age group 21 to 25 years and 1 percent was below 20 years and the rest were above 30 years.
30

3. Most (73%) of the AWWs had job experience below 5 years and the rest had more than 5 years job experience as AWWs. 4. A vast majority of 96% of AWWs was aware of the names of medical staff/doctors and ICDS (doctors attached to AWWs). 5. AWWs had organized health education camps (5%); Nutrition classes and demonstration (10%); Baby shows (20%) and parents meetings (34%). 6. AWWs had made home visits only when it was warranted (29%), whenever occasion arose (11%), to enumerate children especially disabled (5%) and to visit Names (89%), PW (69%). 7. In order to motivate community members to enrol children in AWCs, AWWs had personally visited houses to explain the packages available at the centre (33%). 8. Most of the AWWs (nearly 91%) had expressed that they were involved in Stree Shakthi Programmers and women empowerment programmes, de linking children from child labour and disabled welfare activities. They were leaders of SHGs and also member of other womens group and Balavikasa Samithis. 9. Around 95% of AWWs were attending GP meetings and village education committee meetings and taluk level meetings regularly. 10. With regard to supervisory visits made by supervisors of ICDS, ACDPOs, CDPOs and ICDS doctors and health staff, around 93% of AWWs expressed that supervisors visits once in that supervisory visit once in 3 months and whenever occasion arises they have meetings and interact with them and assign additional tasks and responsibilities. 11. Around 98% of AWWs expressed that ACDPO and/ or CDPOs visit their centres once a year or on occasions whenever higher officials visit them. Most of them have had any officials at the state level. 12. Reactions expressed by AWWs to planning and management of ICDS programme was varied.

During the year 1999 to 2000, number of beneficiaries in the age group 0-6 years was 2397741 out of which 40.41% were of normal weight. Similar figures for 2002 were 2476278 out of which 42.63% were of normal weight. During the year 2003, number of children who had attained normal weight status were 160836 (below one year), 383616 were in the age group 1-3 years, 465305 were between
31

3-5 years. Out of those number of boys were 83909 as compared to 76927 girls (below one year); 160836 boys against 205879 girls (1-3); 177737 boys as compared to 383616 girls (3-5 years). This indicates that there has been an increasing trend in the nutritional status of children over five years.

Number of children who had attained Grade-I status were 891019 during the year 19992000. Similar figures were 879436 during 2000-01; 879436 during 2001-02. In 2003, number of children attaining Grade I status in terms of weight was 123343 (below one year); 378904 (1-3 years); 456223 (3-5 years), out of those 61850 were boys as

compared to 61493 girls (below one year); 189791 boys as against 189113 girls (1-3 years), 212192 boys as compared to 244031 girls (3-5 years). This indicates increasing trends of attainment of Grade-I status by children over years.

Number of children who had attained Grade II status was 446051 during the year 19992000. Similar figures were 431203 during 2000-01; 414198 during 2001-02. In 2003, number of children attaining Grade-II status in terms of weight was 50684 (below one year); 182712 (1-3 years); 200915 (3-5 years), out of those were 25300 boys as compared to 25384 girls (below one year); 88520 boys as against 94192 girls (1-3 years), 97411 boys as compared to 103504 girls (3-5 years). attainment of Grade II status by children over years. This indicates increasing trends of

Number of children who had attained Grade-III status was 11683 during the year 19992000. Similar figures were 10891 during 2000-01; 8943 during 2001-02. In 2003, number of children attaining Grade III status in terms of weight was 602 (below one year); 4458 (1-3 years); 2994 (3-5 years), Out of those 292 were boys as compared to 310 girls (below one year); 1713 boys as against 2745 girls (1-3 years), 1226 boys as compared to 1768 girls (3-5 years). This indicates decreasing trends of attainment of Grade III Status by children over years.

During 2001-02 there were 693 children who were in Grade Status IV. In 2003 number of children who are in Grade IV status is 86 (below 1 year); 430 (1-3 years); 238 (between 3-5 years). Out of those 42 are boys as compared to 44 girls (below 1 year);

32

168 boys as against 262 girls (1-3 years); 102 boys as compared to 136 girls (between 3-5 years) this indicates that the number of children in the Grade IV status is declining.

Quarterly statistical reports from the Directorate of Health and Family Welfare Services (ICDS Wing) also indicate that the percentage of mild malnourishment among ICDS children in the reported years below 6 years population had reduced from 11.84% in March 1998 to 10.44% in March 2001. In case of severe malnourishment, it was reported as being below 1% in all the 4 years.

According to the survey data from six hundred AWCs, higher proportion of pregnant women who were benefited from nutrition and immunisation programme had showed improvement in the nutritional status. This was the perception of over 95 per cent was reported by AWWs that the number of women who were covered under nutritional scheme, at least 90% of women had safe delivery and also the number of women who had delivery with risk was low.

Number of children born with low birth weight had been reduced as reported by AWWs. About 92% of children born were healthier and had normal weight. This is supported by the vital statistics.

Number of live births and deaths of children below 1 years and below 5 years are significant indicators of health status. It has been observed from data from the Office of the Department of Women and Child Development that the reported number of deaths of children below 1 year and 5 years has reduced in the year 1999-2000 to 2001-02.

Observations from the statistical data from Directorate of Health and Family welfare Services (ICDS Wing) show that the percentage of achievement of target in immunization has been fluctuating over the years 1996-97 to 2001-2002. Only during the years 199697, 1997-98 and 2000-2001 that the achievement levels has been above 70% of targets set for Immunization.

During the same year it was observed that children were administered different types of vaccines to immunize. Children (<1 year) were immunized with 69896 (BCG 1 Dose);
33

725\429 (MEASLES 1 Dose); 67782 (DPT 1 Dose); 67818 (POLIO I Dose). II Dose of DPT and POLIO vaccines were given to 70045 and 70704 children respectively. About 74131 and 73132 children received III Dose of the same vaccines. DPT and POLIO boosters were given to children in the age group of below 3 years (49067 and 46175 respectively). About 3318 and 2414 children below the age of 6 years received DT booster and II Dose of vaccine respectively. During March 2003 around 58022 pregnant women was given TT I dosed and 73968 pregnant women were given TT II dose.

Nearly 98% of AWWS have expressed that immunization done at the AWCs has positive impact. A vast majority of children have been covered in the immunization programme. Secondly, immunization done in the AWCs has resulted in improving the health status of children.

Information gathered from AWWs and the data from Department of Health about Health Camps conducted in villages have been varied. In general it was reported by AWWs (nearly 67%) that the frequency of such camps has been declining. This was due to the fact that there has been disinterest exhibited for this activity. The information gathered from Department of Health has been vivid.

According to the data gathered from six hundred AWCs the total number of women who had Malaria (five), TB (six) were less. But the total number of women who had

reproductive related problems was around twenty-nine. Almost all AWWs have reported that the early detection of risk was being done.

As per data furnished by the Department of Women and Children, Children who are beneficiaries of PSE has been showing an increasing trend. Proportion of girls engaged in pre-school education activities is almost similar to that of boys.

As per information obtained from survey of AWCs, there has been steady increase in the participation of children in not only AWCs but also their enrolment in primary schools soon after they complete six years. About ninety per cent of children after completing six years (and gaining anganwadi experience) have reported to enrol in primary schools. This has been reported by a vast majority of AWWs (99%).
34

As reported by AWWs (94%) as well as Primary school teachers (88 out of 100 Primary school teachers contacted) have reported that the ICDS has resulted in increasing participation of girls in schooling. So also the drop out rates among girls has been declining.

The reporting done by primary school teachers on the participation of children (from AWCs) in school activities been better than those who have not been exposed to Anganwadi experiences before entering primary schools. So also their ratings of children on verbal fluency, language ability as well as thoughtfulness are higher. Functionaries of ICDS had perceived that linking AWWs with other departmental activities had hampered the successful implementation of the programme.

Problems Faced by Supervisors

Discussions held with supervisors(nearly 30) of ICDS programme in selected districts expressed their problems in carrying out the activities of ICDS programme.

Problems faced by supervisors were vivid and their intensities varied across districts and blocks in Karnataka. Some of the problems encountered here:

a) b)

Number of AWCs attached to supervisor was more (100%) Number of supervisors recruited is lesser than the number of AWCs. Hence sharing of work between and among supervisors was a burden (20%).

c)

Non-availability of conveyance or transport facilities made supervisors visit to centres limited and also frequency of visits per centre spread to one to three months (41%).

d)

Linking AWWs with other departmental activities have hampered the successful implementation of the programme (23%).

e)

Over burdening of the supervisors with other activities minimizes their work related to ICDS programme (37%).

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f)

Periodical meetings held at various levels of administration needs record maintenance and attendance at meetings that shows down the work related to AWWs (9%).

g)

Non-availability of coordination and cooperation from health and medical staff makes difficult to carry out the tasks assigned (32%).

h)

Utilization of services of supervisors by CDPOs and other officials for various programmes almost halts the successful performance of the task by supervisors (13%).

i)

Communicating to AWWs about various tasks to be performed needs much time and offering guidelines is a tiring task (30%).

j)

Monitoring and evaluation of AWWS performance gets restrained as they undergo strike, absent themselves from work and disinterest exhibited due to lower rates of honorarium received and delay in distribution of the same every month (59%).

k)

Non-cooperation from members of the community and political interference to penalize or punish AWWs comes in the way of successful implementation of ICDS programme (37%)

l)

As AWWs forum is very strong, it is difficult to control the activities of AWWs (11%).

m)

Transfer and promotion to higher positions makes supervisors reschedule their work, which acts as a blockade for AWWs.

n)

AWWs operating leaders of SHGs and members of several committees makes them empowered and thus results as a threat to supervise or monitor activities of AWWs by supervisors (42%)

o)

Supervisors are not decision makers hence they carry out liaison between officials and grass root level workers, which restrains their tasks and roles (50%)

p)

Supervisors have low status and hardly are recognized by community members (26%).

Some of the Suggestions made by Supervisors: 1) 2) 3) De link activities of women development from ICDS programme. Set up a separate department to cater to ICDS programme Supervisors need capacity building programme and hence a separate cell could be set up to train them.
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4)

Wider publicity needs to be given to make community members aware about the role and status of supervisors.

5)

C and R rules need to be revised to provide more facilities and incentives to supervisors.

6) 7)

Manpower planning is needed to recruit supervisors as per requirement. Para-supervisory staff may be appointed to strengthen their supervisory work

8)

Career advancement policies need to be chalked out to enable supervisors for promotional opportunities.

9) 10)

Study leave provisions should be made to pursue higher education Job responsibilities of supervisors need to be limited to only ICDS work.

Opinions Expressed by Primary School Teachers About Children

After collecting information from AWWs, Primary Schools were visited and a schedule was canvassed. Information about the children who had enrolled in primary classes were collected. Besides this a number of queries were made to know about opinions about children who enrol in primary schools were gathered. Teachers had expressed that nearly 98% of the children in the classes hailed from AWCs. It was interesting to note that a vast majority (95%) of such children were regularly attending primary I standard. Whereas children who had enrolled in primary classes without attending any pre primary classes or AWWs were very few in number. But they were not regularly attending classes. Similarly, such children (about 69% of them) were withdrawing from schools without completing primary IV standard. It was not so in the case of children who had anganwadi experiences.

Teachers further reported that there were differences in the entry behaviour of children from AWCs as compared to those who did not. They felt that the children who came from AWCs were actively participating in learning programmes, were punctual, well disciplined and were maintaining healthy habits. They also had developed

communications skills, expressed their wants and desires and exhibited co-operative behaviour. They were alert and attentive in classes and could participate in play activities as well narrated stories and recited rhymes; at the same time sketched the drawings and had limited writing skills.
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Teachers at the same rated a few randomly selected five students with regard to their performance in classroom activities, health status, participation in learning activities.

There were no differences in the performance between and among children belonging to SCs, STs, OBCs and linguistic and religious minorities. Hardly any gender differences were noticeable.

Factors that contributed to the Successful Implementation of the Programme

Factors that contributed to the successful implementation of various schemes under ICDS were a well knit Administrative and Organizational Structure, Cooperation from Directorate of Health and Family Welfare, Communication Network, Management of Information System and Decentralization of Planning, Monitoring and Evaluation of the programmes in a phased manner and getting feed back from internal and external agencies periodically. However, regional variations were observed in terms of coverage of beneficiaries as well as quality of services offered to children and women. Periodical Divisional Level meetings of Officials were held and review of the progress made were discussed.

Most of the AWWs in AWCs were aware of the package of ICDS programme and were trained to maintain records and registers. They were trained and cooperated in

immunization programme with health workers, conducted health and nutrition education demonstrations and participated in Village Education Committee meetings and other meetings held at grassroots level.

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CHAPTER-5 SUMMARY, CONCLUSIONS AND RECOMMENDATIONS

Summary Karnataka is located in southern part of India and is rich in natural resources like rivers, mountains, forests and so on. It is well known for its tourist and industrial potential. The State spreads across an area of 1,91,791 square kilometres and has 27 districts and 176 taluks. Department of Women and Child Development organizes Integrated Child

Development Schemes (ICDS) in Karnataka. It comes under ZP sector.

Objectives of ICDS are:

To improve the nutritional and health status of the children in the age group of 0 to 6 years To lay the foundations for proper psychological, physical and social development of the child To reduce the incidence of mortality, morbidity, and malnutrition and school dropouts. To achieve effective coordinated policy and its implementation amongst the various departments to promote child development To enhance the capability of the mother to look after the normal health and nutritional needs of the child through proper nutrition and health education.

Integrated Child Development Scheme in Karnataka began as one of the pilot projects in India during 1975-76 in the Taluk of T Narasipura in Mysore District. Since then there has been rapid expansion of the ICDS programme in the past two decades.

Currently there are 185 projects functioning in 176 taluks in 27 districts of Karnataka, out of which 166 are Rural, 10 Urban and 9 tribal projects and all projects belong to the central sector.

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Objectives of Evaluation

1)

To identify the factors that are operating for successful implementation of the programme.

2)

To examine the constraints faced by the functionaries involved in the ICDS programme.

3)

To study the impact of package of services Supplementary Nutrition Programme (SNP) Nutrition and Health Education Immunization Health Check up Referral Services Non-Formal Pre School Education

4)

To offer suggestions and recommendations for the improvement of the programme.

A Survey design was used to select (randomly) six hundred anganwadi centres (formed ten percent of total anganwadi centres at the district levels) from ten blocks across five districts in Karnataka. These included Honnavar and Supa in Uttara Kannada, Aurad and Bhalki in Bidar, Hospet and Sandur in Bellary, Bangalore Urban and Anekal in Bangalore Urban Districts. Both secondary and primary data were collected. Both quantitative and qualitative data were collected. Schedules were canvassed for Anganwadi Workers and discussions were held among one hundred Supervisors. Discussions were held with CDPOs and Officials at the block and state levels. Descriptive statistical analysis was carried out to analyse the data.

Conclusions 1. Implementation of ICDS was successfully completed in the State, which could be seen in terms of growth, expansion and coverage of children in the age group 0-6 years, pregnant women and nursing mothers over years since 1975-76. 2. Factors that contributed to the successful implementation of various schemes under ICDS were: a well knit administrative and organizational Structure, Cooperation from Directorate of Health and Family Welfare, Management Information System and decentralization of planning and monitoring and evaluation of the programmes regularly.
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3. Inter district disparities were observed in terms of coverage of beneficiaries. 4. Some of the problems encountered by the functionaries were: inadequate infrastructure facilities, equipments, furniture, play materials, seating arrangements, sanitation and toilet facilities for children in Anganwadi Centres. 5. Anganwadi Workers had low pay and were overburdened with women development programmes. 6. Distribution of Supplementary Nutrition Programme (SNP) Nutrition and Health Education, Immunization, Health Check Up, Referral Services had resulted in improvement in the nutritional and health status of children and women. 7. Supervisors had felt that they had more centres to supervise 8. Children who have had anganwadi experiences were enrolling themselves in primary schools and were fairing well as reported by primary school teachers.

Recommendations 1. ICDS cell needs to be strengthened in terms of resources as the resource devoted is not sufficient to meet the requirement. 2. The problems plaguing the ICDS, in terms of inadequate number of anganawadi workers, inadequate and irregular payments to them need to be addressed immediately. 3. Emphasis should be given to all the three sub stages (i.e., conception to one month, less than three years and 3-6 years) of the programme as against the current concentration on the last stage i.e., 3-6 years age group. 4. Set up an Action Research Cell to conduct studies on child development and level of malnourishment in Anganwadi areas and non-Anganwadi areas. 5. Involvement of community in the provision of Infrastructure facilities like, equipments, furniture and seating facilities, educational Play materials, crayons and colourful books and drawing and painting materials etc.. to the Anganawadi centres. 6. Appropriate change in the location of the Anganawadi centre, which is mostly situated in the main village and it restricts the access to the people who are situated slightly far from the main village i.e., hamlets. 7. Sanitation facilities need to be provided for Children and AWWs in a phased manner. 8. Nursery gardens should be encouraged wherever space is available

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9. Extending the timings of the Anganawadi centres. The current policy of running the centre for 4 hours a day restricts many poor households, who are mainly wage earners where both husband and wife works for long hours, in accessing the facility. This further emphasises on the increase in resources. 10. Awards and incentives for best performance need to be extended to CDPOs, Supervisors and Officials at the regional and district levels 11. AWWs need to be provided with quarters 12. Satellite communication network needs to be set up to collect and collate information network and AWWS need to be trained to feed the data, store and retrieve data. 13. Public, community members, parents, Balavikas Samithis, Stree Shakthi groups should be made accountable for ECD activities. Mass campaigns need to be carried out to create awareness about child rights and Education as a fundamental right. 14. ZPs, TPs and GPs need to be offered orientation training to take care of ECD programmes.

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