Project assistance completion report : integrated child development services project (386-0476)

In spite of a slow start, the project was eventually successful in achieving its goals. Against an initial target of 4,000 the ICDS program was expanded to nearly 4,500 anganwadis, which are fully functional with trained workers. In the target districts, children"s health and nutrition status has improved, infant and toddler mortality rates are lower, and mothers are receiving better pre- and postnatal care. The anganwadis have been staffed with project-trained village health workers and supervision of anganwadis has been improved as has coordination with the health system. Many of these benefits are likely to be sustainable. The nutrition and supplementary feeding component achieved most of its goals of reduced infant and child malnutrition and mortality. However, while the project was successful in reducing the incidence of moderate and severe malnutrition, so far there is no evidence that there has been any impact on long-term malnutrition. Food distribution, which was the responsibility of the state governments, was satisfactory in both states; rations are now provided to all pregnant women rather than only to those in the third trimester, which along with the accompanying rise in health services in the anganwadis should lead to improved nutritional status and fewer low-weight births. The nutrition and health education component had to be redesigned when the expected GOI support failed to materialize. While the component did eventually contribute to the project"s success, it did not have as much impact as hoped; particularly disappointing was the use of mass media. Fortunately, the lack of government counterpart support was partially made up for by the competence of health workers in using the project"s printed educational materials. Training elements were outstanding, particularly the Mobile-In-Service Training (MIST) program, under which 19,000 ICDS and health functionaries were trained. MIST training not only produced a cadre of trained workers to staff the anganwadis by training supervisors, who in turn trained front line-workers, it helped to ensure sustainability and replicability; further, by training health and ICDS workers together, MIST contributed to improved coordination in the field between ICDS functionaries (who report to social welfare agencies) and health care workers (who report to state and central ministries of health). The MIST methodology is now being replicated in an additional district in each state with the enthusiastic support of the GOI. In addition to MIST the project also supported a series of short-term training sessions abroad for senior ICDS management and training personnel, and workshops for mid-level ICDS personnel. Other than training, the management information system (MIS) developed under the monitoring and evaluation component was the project"s most successful aspect. The computerized MIS became a key element of the ICDS, and the GOI has agreed to a countrywide expansion. The research conducted under the project on low birth weight (LBW) produced substantial data, much of which has yet to be analyzed; one study suggested that dietary supplements for mothers can increase birthweights by almost a quarter kilogram on average. The GOI has expressed an interest in exploiting the data from the LBW research in planning for the future of the nationwide ICDS program, and has requested TA in doing so, as well as in analyzing the data produced by the series of impact evaluation surveys. Finally at the policy level, the project by prompting the GOI to expand its use of the private and NGO sectors in the ICDS program has demonstrated the important role the private sector can play in health programs. Lessons learned include the following. (1) The improvement in health services was an important factor in the achievement of nutritional goals, demonstrating the value of a multi-purpose village-based institution such as the anganwadis for delivering health and nutrition services. (2) Mass media techniques -- e.g., radio, videos -- need to be carefully adapted to their target audience; for example, while the project"s traveling "video vans" drew large receptive audiences in the rural villages, the villagers sometimes found the films shown, which portrayed urban characters and situations, to be offensive or irrelevant.