Ongoing PL-480 Title II food aid : CARE - sponsored integrated child development scheme

480 Title II program in India. Midterm external evaluation covered the period from 1979-86 and was based on site visitation, interviews with project personnel and beneficiaries, and document review. In general, the project is being effectively managed. In response to a 1979 evaluation, CARE has increasingly coordinated its provision of P.L. 480 nutritional supplements with the Government of India"s Integrated Child Development Services (ICDS) Program. In 1986, 86% of the food provided under CARE"s maternal/child health program was distributed through ICDS centers. Coordination with State and ICDS officials has been good, and CARE"s management information system serves as a useful tool for both CARE and other counterpart agencies. Monitoring and administrative coverage are adequate to excellent and CARE has managed to assure regular food deliveries with only a few interruptions due to delays in U.S. food shipments. The results of CARE"s outreach program are mixed. CARE has effectively reached children in the 3-6 age group and participation among children aged 2-3, while not satisfactory, is improving. CARE has not been effective, however, in reaching the most nutritionally vulnerable group, children under two. Enrollment and attendance are low for children aged 13-24 months, minimal for those aged 0-12 months. Increased flexibility at ICDS centers to meet the time constraints of pregnant and lactating women would help to increase attendance among younger children. Nutrition education in general needs to be strengthened. Audiovisual aids, such as charts and posters, are outdated where present. Growth monitoring by ICDS workers is improving in accuracy as a targeting tool, but is not functioning effectively as a means of nutrition education nor as a point of departure for linkages to other health interventions. Action decisions are to make systematic monitoring visits to ICDS centers, provide additional training to ICDS workers to emphasize the importance of growth monitoring (including weighings at home for those at risk), develop and use audiovisual and print materials to educate ICDS personnel and the entire community, and adapt corn soy milk recipes to make them more palatable as a weaning substitute. The program teaches that integrated community-based service provision does not necessarily reach priority target groups; flexibility (e.g., allowing food to be taken home under some circumstances) is required. Also, more attention should be given to preventative feeding strategies; children with normal or nearly normal growth are often considered ineligible for food aid, although they could very easily become malnourished, at which point recuperation is slow and costly.