1. Analysis of positive deviance in ICDS Educational Resource Unit Vimala Ramachandran 22 September 2004

2. Educational Resource Unit 2 Specific issues explored Centre-related: Targeting of poor households and children under 3 years Services: location, regularity, activities Worker related: AWW and AWH; Supervisory staff Management factors: State, district and Block, supply and logistics, monitoring and support, training Community related: Interface with community groups, PRI

3. 22 September2004Educational Resource Unit 3 Note! Our aim was to understand the situation we encountered - positive and negative, analyse why something does or does not work in a given environment. The findings of this qualitative study does not purport to be an evaluation of the ICDS programme in the two states. Views expressed are those of the researchers and not W Bank or the 2 State Governments.

4. 22 September2004Educational Resource Unit 4 The findings Strong, mild and negative processes and outcomes explored with reference to Workers Centres Community Management Others

5. Factors explaining positive deviance or lack of it Key findings

6. 22 September2004Educational Resource Unit 6 The human factor Primary objective as articulated by state leadership: Emphasis on targeting of poor, SC/ST Timely procurement and supply of SNP Fixed health-day Under-3s – take home rations (No demonstration to manage grade 3 / 4 malnourished)

7. 22 September2004Educational Resource Unit 7 Targeting of poor House-to-house surveys, weights (the only growth indicators being used) of 0-6 years, malnourished (grades 1 and 2 and grades 3 & 4) children (We did not find names!) The following order adhered to: BPL families IRDP families Landless labour or small marginal farmer ST and SC families

8. 22 September2004Educational Resource Unit 8 The human factor (2) District and Block functionaries take the cue from the state leadership Banswara (Raj) DPO proactive Was PD in Rajasthan WDP – committed and pro- poor Monthly health-day – closer coordination with health department, Importance to supply logistics – committee constituted for tenders to supply up to AWC level Average time-lag of supply after SNP received at Block level is 10 days

9. 22 September2004Educational Resource Unit 9 The human factor (3) Cluster level (Lady Supervisor) and AWC level crucial Dynamic and motivated LS makes a big difference, LS who worked as Pracheta in WDP were cut above rest Training of LS and AWW makes a difference Garhi a model Block since inception of ICDS Perceived status of AWW: Bottom of the chain, low status, given FP and SHG targets, participates in campaigns and surveys Outreach to under 3s limited to immunisation and health-day only

10. 22 September2004Educational Resource Unit 10 The human factor (4) Notwithstanding; positive deviance found: Where LS had good rapport with workers, visited regularly Residence of LS and AWW important Where LS and AWW can access Panchayat resources – hand pump, repair and maintenance of centre, jaggery, synchronise timings with school Highly motivated / committed LS can offset unresponsive / unmotivated CDPO

11. 22 September2004Educational Resource Unit 11 What is a good AWC? Where village survey completed, poor and malnourished children enrolled PSE happens, health day once a month Record keeping of acceptable level Relationship between AWW and panchayat officials is good SHG groups credits are arranged and utilised Cooperation between Health and Education Departments in the block, panchayat, village; AWW motivation higher than average.

12. 22 September2004Educational Resource Unit 12 Operational procedures Lot to learn from Rajasthan – guidelines and operational procedures formulated and communicated, efforts made to iron out contradictions crept in over the years Location and construction / maintenance Streamlined SNP procurement, supply logistics Selection of AWW & “retirement” age fixed at 58 Target beneficiaries fixed, age-group-wise Weekly menu fixed, distribution 6 days a week Regular payment of honorarium to bank account Recognition for good work - awards

13. 22 September2004Educational Resource Unit 13 Lessons Cohesive guidelines & operating procedures creates positive environment, minimises ambiguities and facilitates clarity of roles and responsibilities among functionaries. When complemented by motivated and efficient leaders at state and district levels, it provides tremendous scope for positive deviance.

14. 22 September2004Educational Resource Unit 14 Since SNP is critical… Ensure adequate and uninterrupted supply Minimise time-lag: receipt at block & supply to AWC Cooked meal better than dry & ready to eat Palatable food a must: link up with Panchayat to supply jaggery, spices, vegetables (where centralised procurement problematic) – good practice in Bellary Arrangements for fuel, cooking space and water Distribute SNP 2 times – 10.30 and 12.00 – facilitates better uptake / absorption by children and ensure children stay for 4 hours;

15. 22 September2004Educational Resource Unit 15 Under 3s Casual approach to nutrition education to mothers / care providers Take-home rations the norm for under-3s, immunisation done, growth monitoring done but we could not tally data with real children!) Evidence of referrals in Raj – good Block PHC, resident doctor couple

16. 22 September2004Educational Resource Unit 16 Targeting mothers SNP distributed to 10 pregnant & 8 lactating women and 2 adolescent girls in Raj But AWW do not check if pregnant woman are registered with ANM for antenatal care No nutrition education, few tips mentioned in passing Rajasthan: AWW have FP targets, SHG targets. LS have targets to link SHGs to banks Poorest women in village not part of SHG – AWW not interested in them. Focus more on one layer above – those who have some means to save.

17. 22 September2004Educational Resource Unit 17 Growth Monitoring (GM) Aggregate data given by LS / CDPO This could not be verified in 60 percent of cases! Weights and names given in registers, no age! 0 to 3 weighed on health-day, same children not tracked from month-to-month Data available – but has little meaning as it is not child specific No connection between nutrition status and quantity of SNP, anyone who comes is fed

18. 22 September2004Educational Resource Unit 18 Pre-school education Rajasthan: recent efforts to give refresher training in PSE (ex-Shiksha Karmi Director made in-charge) No evidence of play-way / child-centered processes, as yet

19. 22 September2004Educational Resource Unit 19 Convergence ICDS does not stand alone: Proactive Sathins and energised education system make people confident to access government programmes. When programme uptake goes up, pressure on worker to provide services increases. Converse is also true: ICDS cannot shine by itself if the health system is dysfunctional, primary schools over-crowded, teachers indifferent, there is no independent forum for women to come together and governance is poor.

20. 22 September2004Educational Resource Unit 20 Information flow and monitoring 15 + registers maintained AWWs burdened, many pay Rs 100/ a month to someone to help with record keeping Most important information, i.e., children grade 2, 3 and 4 malnourished not available by name! Most important channel is monthly meetings – data submitted No systems for tracking malnourished children Put a face to the numbers

21. 22 September2004Educational Resource Unit 21 Community interface Can potentially make a big difference Encountered active / interested SHG, Panchayat leaders Did not come across effective mother’s committee, routine minutes, repetitive month after month, across AWCs Women more aware in villages where Sathins were active (Raj)

22. 22 September2004Educational Resource Unit 22 What we saw in Garhi Block Though not part of study sample, visited Garhi (Banswara) - told of “good practices” AWW selected and trained pilot phase in mid-1970s Close inter-flow between ICDS and WDP, LJP also working in this area (micro-planning), SHG also fairly active, functioning PHC, TLC was vibrant CDPO proactive – used relief work to upgrade and maintain facilities NGO Vihan providing continuous training inputs Functioning AWC, food distributed twice, pre-school education interesting, workers energetic