End Line Evaluation of ICDS-II in MP

Introduction

The Integrated Child Development Services (ICDS) was launched in India to enhance the welfare and development of children and women. This programme was launched on 2nd Oct. 1975 with an objective of promoting the overall development of children under 6 years by strengthening the capacity of caretakers in the family and community. This was to be achieved by improving their access to the basic services needed for improvement of health and nutrition.

The main objectives, of ICDS programme are:

1. Improve the nutritional and health status of children below the age of 6 years.
2. Lay the foundation for proper psychological, physical and social development of child.
3. Reduce the incidence of mortality, morbidity, malnutrition and school dropouts.
4. Achieve effective co-ordination of policy and implementation among various departments to promote child development.
5. Enhance the capability of the mothers to look after health and nutritional needs of the child, through proper health and nutrition education, and,
6. Care of essential needs of pregnant women and lactating mothers of weaker sections of the society.

In Madhya Pradesh ICDS programme was first launched during 1975-76 in Baidhan a rural block of Singrauli, dist. Sidhi and Tokapal, a tribal development block of Bastar district. Later this programme was further extended to Susner block of Shajapur district, Nagod block of Satna district and urban areas of Jabalpur. Till 1986 ICDS programme in M.P. was implemented in tribal areas by Tribal Welfare Department and in non-tribal areas by Social Welfare Department. The ICDS was shifted to Women and Child Development Department in 1986 formed for this purpose.

The ICDS programme in the state is implemented through team approach. At block /project level, the team is headed by a Child Development Project Officer (CDPO) and Supervisors at sector level and Anganwadi Workers (AWWs) at village / AWC level.

The ICDS II Project in M.P.

The ICDS II project in M.P. was covering 336 blocks of 45 districts in the state. Out of these project 216 projects were being operated in rural areas, 23 in urban areas and 97 in tribal areas. These were further grouped as 185 World Bank New, 65 World Bank Old and 86 ICDS General projects.

The main focus of the study was to assess the existing level of ante and postnatal care (i.e. early registration, T.T. injections, IFA tablets etc.), breast feeding practices, child care practices, awareness about anganwadi centres, nutrition status of children and growth monitoring, training of anganwadi workers, and their awareness about child feeding, maternal care etc. The findings of the study may serve as indicators for measuring the progress and planning for future.

Research methodology and coverage of study

A combination of research techniques, such as quantitative, qualitative, and desk research have been used in the study. The information related to this study has been collected from heads of households, mothers of children aged 0-3 years and 3-6 years, pregnant women, lactating women, adolescent girls and anganwadi workers. Besides the interviews among above categories group discussions and case studies were also conducted.

Sampling criteria

The present study has been conducted in 17 ICDS projects. Total number of anganwadi centres covered were 102. The study has been conducted in two phases. In the first phase an enlistment of households was carried out and in second phase detailed interviews of the sampled beneficiaries, group discussions and case studies were carried out. The sample size for different categories was household 12713, pregnant women 545, lactating women 650, children 0-3 yrs. 4716, children 3-6 yrs.2728, adolescent girls 1323 and AWWs .93.

Data analysis

After data collection the exercise of field editing of data was conducted at field level. After field level editing the data was brought to headquarters and second phase of office editing of data was performed. Then the data was entered into computer though software and was again rechecked. The analysis of data was performed by using SPSS. 9.0 version & EPI Info 6-0.

Salient findings of the study

The summary of findings of the study are given for different category of respondents as under:

Household characteristics

Basic information, related with household, was collected from 12713 heads of households. The socio-economic profile of the households is given below: -

1. 94 percent of the heads of households were males. Nearly 50 percent of them were illiterate. The percentage of illiterate heads of households was highest (63 percent) in tribal projects. Out of them 93 percent of heads of households were Hindus and only 6 percent were Muslims. Out of them 20 percent were scheduled castes, 23 percent scheduled tribes and 42 percent were OBCs. The main occupations of the head of households were either wage labour (42 percent) or agriculture (42 percent). In urban areas 41 percent were wage labours, 4 percent were agriculturists, 25 percent were salaried people and 21 percent were traders/business men.
2. Overall 30 percent heads of households had monthly income below Rs. 750. In tribal projects 40 percent, in urban projects 6 percent and in rural projects 29 percent had monthly income below Rs. 750. In urban general projects 17 percent, in rural general projects 5 percent and in tribal general projects less than one percent had monthly income above Rs. 5,000.
3. The main source of drinking water was hand pump/bore well (39 percent), well water (36 percent) and tap water (23 percent). The main source of drinking water in urban projects was tap water (70 percent) in rural projects areas, well water (43 percent) and in tribal projects area hand pump/ borewell (54 percent). Out of the total households surveyed nearly 85 percent had no toilet facility in their houses. In tribal projects 94 percent, in rural projects 90 percent and in urban projects 30 percent had no toilet facility.

The economic condition of households was poor particularly in tribal and rural projects. They were at low subsistence level of livelihood.

Pregnant women’s health and nutrition

ICDS programme provides specific interventions for pregnant women by enhancing their capacity to care for themselves and their infants. For gathering information on the issues related with pregnant women. 545 pregnant women were interviewed in sample projects. More than three fourth (79 percent) of the pregnant women were 19 to 29 years of age. The mean age of pregnant women was 24 years. 65 percent of pregnant women were illiterate and 12 percent were educated till middle school. Whereas 4 percent in urban projects were graduates as well. The salient outcome of the study was as follows: -
1. Only 57 percent pregnant women were administered T.T. injections. Of these only 51 percent were administered atleast two injections. Only 45 percent had gone through ANC check-ups by doctors. About 59 percent pregnant women were not aware of the benefits of ANC check up. Most of the pregnant women (83 percent) were aware about the existence of AWC in their village and 42 percent were registered in AWCs. Only 18 percent pregnant women got themselves registered within 4 weeks of pregnancy. Weight of only 12 percent pregnant women was recorded every month in the AWCs.

2. Maximum advice on breast feeding, childcare and nutrition was given by elderly women (81 percent). Only 10 percent pregnant women received advises on these issues from AWWs and ANMs.

Lactating women

The ICDS programme reaches lactating women with an objective of enhancing their capacity to care for themselves and their children during lactating period. The data was collected from 650 lactating women on their present health and nutritional status as well as their awareness about the programme. The mean age of lactating women interviewed was 24.8 years. The agewise distribution of lactating women was as follows- maximum in the age group 19-24 years (47 percent) followed by 25-29 years (33 percent) and 30-35 years (13 percent) only. The proportion of illiterate women was found high (64 percent). This proportion was found higher in tribal projects (76 percent) compared to rural (63 percent) and urban (37 percent) projects. The salient findings of the study are given below: -
1. Nearly one third of lactating women had not taken IFA tablets and only 7 percent took upto 100 tablets. The status of TT injections administered during pregnancy in the state was high. (76 percent). Among lactating women who took at least two injections during their pregnancy was 71 percent.
2. During delivery 83 percent of lactating women faced no complications. The major complications faced were extended labour pain (11 percent) and excessive bleeding (5 percent). Home was the most preferred place of delivery among 81 percent lactating women interviewed. Highest percentage (93 percent) of home deliveries was found in tribal projects followed by rural projects (88 percent) and urban projects (22 percent). The second highest choice for place of delivery (12 percent) was the Govt. Hospital.
3. According to lactating mothers maximum number (77 percent) of new-born children were not weighed at birth. Among those children who were weighed only 42 percent had their weight records with AWCs. It was found that among those children whose birth weights were recorded 27 percent were low birth weight babies.
4. Initiation of breast-feeding after birth with in 2 hours was reported by 37 percent of lactating mothers. In urban projects it was reported by 65 percent lactating women, in tribal projects by 33 percent and in rural projects by 32 percent. Nearly 66 percent lactating women reported that they squeezed out milk prior to breast feeding the child. Majority of them said that this was done either on the advice of elders or because of local customs.
5. Nearly 81 percent of lactating women reported the nutritional status of their child was normal. 26 percent of mothers interviewed intimated about the sickness of their child within last 2 weeks. Out of them the major ailments reported were fever (72 percent), Diarrhoea (44 percent) and cough (35 percent). Only 3 percent mothers reported that they have given vitamin A rich food to their children within last 3 days and usage of deworming tablets was found very low (5 percent).
6. A little more than 30 percent of lactating women were collecting supplementary food from AWCs 42 percent of total lactating women opined that AWW had never visited their homes. Breast feeding (34 percent), Nutrition (29 percent), childcare (24 percent) were found the major issues on which AWW had discussed with the lactating women. Only 13 percent of lactating mothers opined that they had been advised by AWWs on breast-feeding, childcare and nutrition, where as 81 percent said that they had been advised by elder women in the family on these issues.

Adolescent girls

ICDS programme defines adolescent girls as unmarried women between the age of 11 to 18 years. Specific programmes have been launched for their optimal development in health and family life. These programmes include health checks ups, supplementation of IFA, and health and family life education.

1323 adolescent girls were interviewed in the study to know about their access to information and services in health and nutrition. The maximum number of girls interviewed was in the age group 11-12 years (33 percent). The mean age was 13.9 years. About 30 percent of girls interviewed were illiterate, 27 percent had primary education and 26 percent had middle level education. Only 4 percent were found above 10th class. The findings of the study are given below: -

1. Intake of vitamins, IFA tablets and supplementary nutrition was 6, 7 and 2 percent respectively among the girls. Most of the girls took IFA tablets (42 percent) only for 1 to 2 months. The main reason was ignorance about IFA tablets. Nearly 83 percent of total girls interviewed had never undergone blood tests.
2. Their access to health/nutrition and family life education was found to be poor (only 17 percent). Whatever information, they had on these issues, was provided by Friends/ Relatives/ Neighbours (36 percent), schoolteachers (30 percent) and AWWs (23 percent). One fourth of the girls were aware about AIDS and their major source of information was mass media (70 percent) and their participation in any women’s group activities was very low (8 percent).
3. The data on food consumption pattern indicates that cereals (100 percent), pulses (67 percent) and vegetables (69 percent) are taken daily by maximum numbers of girls. But consumption of fruits (7 percent), milk and milk products (21 percent) and non-veg items (2 percent) are very low in their daily food. It has been observed that about 55 percent of girls had correct knowledge of legal age at marriage. The girls in urban areas were more aware (78 percent) than rural (58 percent) and tribal areas (33 percent).

Children’s health and nutrition

The early childhood care of children below six years of age is focal point of ICDS programme. Therefore, this programme includes schemes like immunisation, health check ups, growth monitoring, supplementary feeding, referral services and counselling to mothers for promoting better health and nutritional practices. The data on children of 0-6 years have been collected from 7444 mothers. Among the children studied 56 percent were male and 44 percent were female. Out of them 14 percent were below six months of age and 37 percent were between 36 to 72 months of age. The major findings for this category are given below: -
1. Nearly 73 percent of the total children were not weighed at birth. Among those who were weighed, only in 37 percent cases, birth weight was recorded at AWCs and in 28 percent cases birth weight was found below 2.5 Kgs. In 37 percent cases breast-feeding was done within two hours of birth and 63 percent mothers squeezed out their milk prior to breast-feeding. On an average a baby was breast fed 7 times a day on the day before the interview. This was almost similar in tribal, rural and urban projects. The median number of months a child was breast fed was 13 in all projects and was 12 in tribal projects, 14 in rural projects and 14 in urban projects. Nearly 90 percent children were receiving complementary food.
2. The mean age of children for starting semi solid food was found to be around 8 months in all projects (in tribal 8.1, in rural 7.9 and in urban 8.4 months). The main items consumed by children during last 48 hours (2 days) were plain water (97 percent), solid/mushy food (84 percent), tea (64 percent) and fresh milk (49 percent), Tinned/powder milk was given in 9 percent children of urban (new) projects. Doses of vitamin A were provided to 42 percent children. Around 42 percent children also received vitamin A rich food during 72 hours before the survey.
3. Within the last 2 weeks of survey almost 27 percent children were found sick. Out of these 71 percent suffered from fever, 38 percent from cough and 34 percent from Diarrhoea. Nearly 14 percent of children surveyed were given de-worming tablets.
4. Nearly 96 percent mothers of children reported presence of AWC in the village and 66 percent reported registration of their children in the AWC. 33 percent of children were found receiving supplementary food from AWCs. In 37 percent cases mothers confirmed that food for children was being shared by other members of family and nearly 33 percent of children were found attending pre-school education in AWCs.

Anganwadi workers (AWW)

It was decided to interview all the anganwadi workers of sampled AWCs (102) but only 93 AWWs could be interviewed. Most of the AWWs were in the age group 26 to 35 years. Where as 31 percent was in the age group of 26-30 years and 26 percent in the age group of 31 to 35 years. The mean age was 32.3 years. A large number of AWWs were above High school (43 percent). The major findings of the study were as below.
1. 47 percent AWWs received both the trainings and only 2 percent could not get any training at all.
2. Overall 27 percent of AWCs were functioning in Govt. buildings and 44 percent in rented buildings where as in urban areas 92 percent AWCs were functioning in rented buildings.
3. The average number of beneficiaries per AWCs consisted of 39 children of 0-3 years, 34 children of 3-6 years,6 adolescent girls, 9 pregnant women and 10 lactating women.
4. Under Kishori Shakti Yojana on an average 5-6 adolescent girls were enrolled in AWCs. In about 7 percent AWCs weighing machines were not found where as nearly in 95 percent AWCs weighing machines were found in working condition. Nearly 81 percent of children below 3 years of age are weighed once a month. The wall charts were available in 81 percent AWCs and growth charts were available in 83 percent AWCs. In about 30 percent AWC no food stock was found and in 16 percent AWCs food stocks for almost one month was available.
5. The mean number of days pre-school education held was 5.6 in all AWCs, 5.5 in tribal as well as in rural projects and 6 in urban projects. Adequate number of pre school kits were found only in 40 percent AWCs, whereas 92 percent AWCs belonging to urban project had adequate number of kits 71 percent of AWCs had no medicine kits. The reasons were in 64 percent AWCs kits were out of stock but not replenished and in 33 percent cases it was not provided.
6. Family planning measures like pills, condoms and other measures were available in only 48 percent AWCs. Immunisation register and survey register were maintained in 95 percent AWCs.
7. During the first 6 months of pregnancy, anganwadi workers gave a lot of advice to pregnant women. Out of total AWWs 82 percent were advised to eat green vegetables, 79 percent were advised to get TT injections, 74 percent were advised to take care of food, 57 percent were advised to take IFA tablets and 34 percent were advised to get registered in AWCs. The main advice given to lactating mothers included providing colostrum (by 77 percent AWWs), timely Immunisation (by 48 percent AWWs), exclusive breast-feeding (by 44 percent AWWs) and keeping child clothed (by 27 percent AWWs). Seventy five percent of AWWs advised the mothers for breast-feeding to newborn child within one hour after birth. 96 percent of AWWs were aware about providing colostrum to newborn child and 58 percent of AWWs had correct knowledge about exclusive breast-feeding period.

The data were compared with the base line data (1997) and an improvement has been found in the situation.