Endline Evaluation of ICDS-II in Chattisgarh

Introduction
The Integrated Child Development Services (ICDS) were 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 old Madhya Pradesh ICDS programme was first launched during 1975-76 in Baidhan a rural block of Singrauli, dist. Sidhi (now in M.P) and Tokapal, a tribal development block of Bastar district (now in Chhattisgarh). 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 old M.P. was implemented in tribal areas by Tribal Welfare Department and in non-tribal areas by Social Welfare Department. The ICDS programme was shifted to Women and Child Development Department in 1986, which was created for this purpose. The Directorate of Women and Child Development under Govt. of Chhattisgarh is looking after this programme since its formation.

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 C.G.

The ICDS II project in C.G. is covering 152 blocks of 16 districts in the state. Out of these project 61 projects were being operated in rural areas, 6 in urban areas and 85 in tribal areas. These were further grouped as 83 World Bank New, 40 World Bank Old and 29 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 11 ICDS projects. Total number of anganwadi centres covered were 66. 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 8699, pregnant women 314, lactating women 321, children 0-3 yrs. 2962, children 3-6 yrs.1654, adolescent girls 877 and AWWs 59.

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 through 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 8699 heads of households. The socio-economic profile of the households is given below: -

1. 93 percent of the heads of households were males. Nearly 45 percent of them were illiterate. The percentage of illiterate heads of households was highest (55 percent) in tribal projects. Out of them 96 percent of heads of households were Hindus and only 2 percent were Muslims. Out of them 16 percent were scheduled castes, 33 percent scheduled tribes and 39 percent were OBCs. The main occupations of the heads of households were either wage labour (32 percent) or agriculture (51 percent). In urban areas 48 percent were wage labours, 9 percent were agriculturists, 27 percent were salaried people and 12 percent were traders/business men.
2. Overall 31 percent heads of households had monthly income below Rs. 750. In tribal projects 41 percent, in urban projects 8 percent and in rural projects 33 percent had monthly income below Rs. 750. In urban (new) projects 8 percent, in rural (new) projects 3 percent and in tribal (old) projects nearly 5 percent had monthly income above Rs. 5,000.
3. The main source of drinking water was hand pump/bore well (62 percent), well water (22 percent) and tap water (13 percent). The main source of drinking water in urban projects was tap water (50 percent) in rural projects, hand pumps (89 percent) and in tribal projects hand pump/ borewell (47 percent). Out of the total households surveyed nearly 92 percent had no toilet facility in their houses. In tribal projects 93 percent, in rural projects 97 percent and in urban projects 76 percent had no toilet facility.

The economic condition of households was poor particularly in tribal and rural projects. In general people 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. 314 pregnant women were interviewed in sample projects. More than three fourth (78 percent) of the pregnant women were 19 to 29 years of age. The mean age of pregnant women was 23.8 years. 47 percent of pregnant women were illiterate and 18 percent were educated till middle school. Whereas 4 percent in urban (new) and 4 percent in tribal (old) projects were graduates as well. The salient outcome of the study was as follows: -

1. Only 69 percent pregnant women were administered T.T. injections. Of these only 64 percent were administered at least two injections. Only 45 percent had gone through ANC check-up by doctors. About 47 percent pregnant women were not aware of the benefits of ANC check ups. Most of the pregnant women (89 percent) were aware about the existence of AWC in their village and 71 percent were registered in AWCs. Only 6 percent pregnant women got themselves registered within 4 weeks of pregnancy. Weight of only 14 percent pregnant women was recorded every month in the AWCs.

2. Maximum advice on breast-feeding, childcare and nutrition was given by elderly women (64 percent). Nearly 33 percent pregnant women received advice 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 321 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 24.6 years. The agewise distribution of lactating women was as follows- maximum in the age group 19-24 years (53 percent), followed by 25-29 years (25 percent) and 30-34 years (10 percent) only. The proportion of illiterate women was found high (51 percent). This proportion was found higher in tribal projects (67 percent) compared to rural (55 percent) and urban (30 percent) projects. The salient findings of the study are given below: -

1. More than one third of lactating women had not taken IFA tablets (38 percent) and only 11 percent took upto 100 tablets. The status of TT injections administered during pregnancy in the state was high. (89 percent). Among lactating women who took at least two injections during their pregnancy was 85 percent.
2. During delivery 87 percent of lactating women faced no complications. The major complications faced were extended labour pain (7 percent) and caesarean delivery (2 percent). Home was the most preferred place of delivery among 86 percent lactating women interviewed. Highest percentage (97 percent) of home deliveries was found in rural projects followed by tribal projects (94 percent) and urban projects (59 percent). The second highest choice for place of delivery (14 percent) was the Govt. Hospital and Pvt. Hospitals.
3. According to lactating mothers maximum number (72 percent) of newborn children were not weighed at birth. Among those children who were weighed 58 percent had their weight records with AWCs. It was found that among those children whose birth weights were recorded 17 percent were low birth weight babies.
4. Initiation of breast-feeding after birth with in 2 hours was reported by 45 percent of lactating mothers. In tribal projects it was reported by 60 percent lactating women, in urban projects by 37 percent and in rural projects by 36 percent. Nearly 51 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 (52 percent) or because of local customs (28 percent).
5. Nearly 89 percent of lactating women reported the nutritional status of their child as normal. 16 percent of mothers interviewed intimated about the sickness of their child within last 2 weeks. Out of them the major ailments reported were fever (73 percent), diarrhoea (29 percent) and cough (22 percent). None of the mothers reported that they have given vitamin A rich food to their children within last 3 days and use of deworming tablets was found very low (6 percent).
6. Nearly 52 percent of lactating women were collecting supplementary food from AWCs 34 percent of total lactating women opined that AWW had never visited their homes. Breast feeding (30 percent), nutrition (25 percent), childcare (22 percent) were found the major issues on which AWW had discussed with the lactating women. Only 18 percent of lactating mothers stated that they had been advised by AWWs on breast-feeding, childcare and nutrition, where as 73 percent said that they had been advised by elderly women in the family on these issues.

Adolescent girls

ICDS programme defines adolescent girls as unmarried girls 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.

877 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 13-14 years (31 percent). The mean age was 14 years. About 19 percent of girls interviewed were illiterate, 26 percent had primary education and 42 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 31, 4 and 3 percent respectively among the girls. Most of the girls took IFA tablets (50 percent) only for less than1 to 2 months. The main reason was ignorance about IFA tablets. Nearly 80 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 25 percent). Whatever information, they had on these issues, was mostly provided by school teachers (31 percent), friend/relatives/neighbours (21 percent) and AWWs (13 percent). Ninteen percent of the girls were aware about AIDS and their major source of information was mass media (57 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 (55 percent) and vegetables (82 percent) are taken daily by maximum numbers of girls. But consumption of fruits (2 percent), milk and milk products (4 percent) and non-veg items (1 percent) are very low in their daily diet.

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 4616 mothers. Among the children studied 55 percent were male and 45 percent were female. Out of them 11 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 72 percent of the total children were not weighed at birth. Among those who were weighed, only in 52 percent cases, birth weight was recorded at AWCs and in 17 percent cases birth weight was found below 2.5 Kgs. In 44 percent cases breast-feeding was done within two hours of birth and 54 percent mothers squeezed out their milk prior to breast-feeding. On an average a baby was breastfed 8 times a 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 18 in all areas and was 15 in tribal projects, 20 in rural projects and 14 in urban projects. Nearly 89 percent children were receiving complementary food.
2. The mean age of children for starting semi solid food was found to be around 7 months in all projects (in tribal 6.8, in rural 7.2 and in urban 6.9 months). The main items consumed by children during last 48 hours (2 days) were plain water (99 percent), solid/mushy food (88 percent), tea (45 percent) and fresh milk (23 percent), Tinned/powder milk was given in 5 percent children of urban (new) project. Doses of vitamin A was provided to 41 percent children. Around 65 percent children also received vitamin A rich food during 72 hours before the survey.
3. Within the two weeks proceeding survey almost 21 percent children were found sick. Of these 77 percent suffered from cough, 27 percent from fever and 29 percent from diarrhoea. Nearly 21 percent of children surveyed were given de-worming tablets.
4. Nearly 99 percent mothers of children reported presence of AWC in the village and 83 percent reported registration of their children in the AWC. 58 percent of children were found receiving supplementary food from AWCs. In 44 percent cases, mothers confirmed that food for children was being shared by other members of family and nearly 51 percent of children (3-6 years) were found attending pre-school education in AWCs.

Anganwadi workers (AWW)

It was decided to interview all the anganwadi workers of sampled AWCs (66) but only 59 AWWs could be interviewed. Most of the AWWs were in the age group 21 to 30 years. Out of them 25 percent were in the age group of 21-25 and 32 percent in the age group of 26-30 years. The mean age was 31.6 years. Nearly one third of AWWs were above High school (34 percent). The major findings of the study were as below.
1. 76 percent AWWs received both the training and only 2 percent could not get any training at all.
2. Overall 49 percent of AWCs were functioning in Govt. buildings and 41 percent in rented buildings where as in urban areas 82 percent AWCs were functioning in rented buildings.
3. The average number of beneficiaries per AWC consisted of 37 children of 0-3 years, 33 children of 3-6 years, 4 adolescent girls, 8 pregnant women and 9 lactating women.
4. Under Kishori Shakti Yojana on an average 2-3 adolescent girls were enrolled in AWCs. In about 3 percent AWCs weighing machines were not found where as nearly in 73 percent AWCs weighing machines were found in working condition. Nearly 88 percent of children below 3 years of age are weighed once a month. The wall charts were available in 76 percent AWCs and growth charts were available in 71 percent AWCs. In about 27 percent AWC no food stock was found and in 20 percent AWCs food stocks for almost one month was available.
5. The mean number of days pre-school education held was 5.7 in all AWCs, 5.9 in tribal as well as in rural projects and 5 in urban projects. Adequate number of pre school kits were found only in 32 percent AWCs, whereas 27 percent AWCs belonging to urban project had adequate number of kits 86 percent of AWCs had no medicine kits. In 69 percent AWCs kits were out of stock but not replaced and in 31 percent cases it was not provided.
6. Family planning measures like pills, condoms and other measures were available in only 44 percent AWCs. Immunisation register and survey register were maintained in 90 percent and 95 percent centres respectively.
7. During the first 6 months of pregnancy, anganwadi workers gave a lot of advice to pregnant women. Out of total AWWs 86 percent were advised to get TT injections, 75 percent were advised to eat green vegetables, 70 percent advised to take IFA tablets, 64 percent were advised to get registered at AWCs and 58 percent were advised to take care of food. The main advice given to lactating women included, providing colostrum (by 81 percent AWWs), timely Immunisation (by 68 percent AWWs), exclusive breast-feeding (by 66 percent AWWs) and keeping child clothed (by 41 percent AWWs). Seventy three percent of AWWs advised the mothers for breast-feeding to new-born child within one hour after birth. 97 percent of AWWs were aware about providing colostrum to new-born child. 95 percent of AWWs had correct knowledge about exclusive breast-feeding period.